Summary of our Five Year Strategic Plan 2015 - 2020 · our Quality Account ... • The delivery of...
Transcript of Summary of our Five Year Strategic Plan 2015 - 2020 · our Quality Account ... • The delivery of...
SummaryofourFiveYearStrategicPlan|2015-2020
1 A great place to be cared for; a great place to work.
A great place to be cared for; a great place to work.
Summary of our Five Year Strategic Plan2015 - 2020
SummaryofourFiveYearStrategicPlan|2015-2020
2 A great place to be cared for; a great place to work.
Contents
Section Item Page
Introduction 4
1 ExecutiveSummary 7
2 MarketAssessmentandCommissioningLandscape 12
3 TheClinicalModel 22
4 WorkforceandOrganisationalDevelopmentStrategy 30
5 TheEstatesStrategy 39
6 TheITandInformaticsStrategy 44
7 TheQualityStrategy 47
8 TheFinanceStrategy 50
9 Conclusion 57
Theinformationcontainedinthisdocument
weunderstandtobecorrectatthetimeof
goingtopress.Aswestrivetoimproveasan
organisation,figuresandinformationare
subjecttochange.
SummaryofourFiveYearStrategicPlan|2015-2020
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SummaryofourFiveYearStrategicPlan|2015-2020
4 A great place to be cared for; a great place to work.
Introduction
OverthelasttwoyearstheTrusthascontinuedto
makesignificantprogressinitsrecovery,followinga
threestageprogrammeofstabilisation,transition
andtransformation.
TheTrustsetoutplansinitsOperationalPlan*
2014-2016,submittedinApril2014,fordelivering
highqualitysustainableserviceswithintheresources
availableoverthenexttwoyears.Researchhasshown
thatoperatingasitdoes,acrossthreemainsites
coveringawidegeographicalareawithrelativelylow
volumesofactivity,isunsustainableandcannotcontinue.
InourOperationalPlan2014-16,theTrustacknowledged
thatwewouldbemakingfurtherrevisionstoour
plansfollowingpublicationofthe‘bettercaretogether’
strategyinJune2014.
‘Bettercaretogether’isaclinicallyled,health
economy-wideprogrammeandisthemainroute
throughwhichtheTrust’slong-termfuturewillbe
delivered.Throughoutallofourplans,ourpriority
remainsthatofdeliveringhighquality,safeservices
thatmeetstheneedsandexpectationsofourpatients
andrequirementsofourregulators.
Attheheartofallourproposalsisanewmodelof
“outofhospital”careinwhichlocalGPpractices
becomethegatewayforpeopletoaccessallcare,
includinghospitalservices.GPswillworkcloselywith
awiderangeofotherhealthandcarepractitionersto
ensurepeople’sneedsaremet,andindoingsoreduce
delaysandexpenseintheexistingsystem.
*Find out more.
TheTrust’sOperationalPlanisavailableonourwebsite:
www.uhmb.nhs.uk
Underthisnewmodel,responsibilityforhealthand
carewillbecomeatruepartnershipbetweenpeople,
GPsandotherhealth-carestaffinthecommunity.
Therewillbeamuchmoreproactiveapproachto
care,wherebylocalintegratedcareteamswillidentify
patientsatrisksothattheycanreceivethesupport
theyrequirebeforeacrisisoccurs.Peoplewillbe
empoweredtomakelifestylechoicesthatwillkeep
themhealthyforlongerandtomanagelong-term
conditionsathomewiththeuseoftechnology.Fewer
elderlypeoplewillendupspendingtheirlastdaysin
hospitalbecausetherewillbetheoptionforthemto
becaredforathome.
Hospitalserviceswillwraparoundthisnewmodelof
carewithemergencycareandconsultant-ledmaternity
unitsremainingascoreessentialservicesateither
endofourpatch.Allowinghospitalstofocusonthe
aspectsofcarethatonlytheycanprovidewilldriveup
standards,reducethelengthofhospitalstays,improve
waitingtimesandinmanycasesreducetheneedfor
patientstotravel.Thisnewwayofworkingwillalso
reducecoststhroughmoreefficientuseofresources.
Inaddition,thereistheopportunityformanyhospital
stafftoprovidetheirexpertisewithinacommunity
setting,takingcaretothepatientratherthanbringing
thepatienttothehospital.
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Throughthe‘bettercaretogether’strategytheTrust
willworkwithitspartnersacrossthelocalhealth
economyto:
•Developout-of-hospitalservicemodelsinallthree
localitiesthatarecapableofreducingthefuture
needanduseofhospitalservices,resultinginthe
releaseofhospitalservicecapacityandinfrastructure;
•Retainkeyessentialservicesinallthreelocalities
toprovideAccidentandEmergency,24hour
accesstourgentcareandmaternityservices:
Givenourgeography,muchoftheMorecambeBay
populationisunabletoaccessalternativeservices
withinatraveltimeof45minutestoonehour;
•Developconfigurationoptionsforsurgical
servicesthatimproveserviceefficiency,quality,
patientexperienceandsustainabilityofservices;
•Deliverprojectednetsavingsofapproximately
£23m,dependinguponthescaleofchange
deliveredandinvestmentrequired;
Thefollowingin-hospitalserviceswillstillbeprovided
acrossMorecambeBay:
•AccidentandEmergency(Type1)anddependent
servicesatFurnessGeneralHospitalandRoyal
LancasterInfirmary;
•WestmorlandGeneralHospital:PrimaryCare
AssessmentServiceprovidedbyCumbriaPartnership
NHSFoundationTrust;
•MaternityserviceswithobstetricfacilitiesatFurness
GeneralHospitalandRoyalLancasterInfirmary;
•MidwiferyledunitatWestmorlandGeneralHospital;
•Electiveservicesanddaysurgery.
Communityteamswillbedevelopedoutofhospital
withineachlocalityandwillbemadeupof:
• Integratedcoreteam;
•Urgentcareco-ordinationcentre
(withachildspecificservice);
• Integratedrapidresponseteamsforadultswith
separateteamsforchildren;
•Communityspecialistservicesforbothadultsand
children;
•Referralsupportsystemforbothadultsandchildren.
Throughoutallofourplans,including‘bettercare
together’andourfiveyearstrategy,ourpriority
remainsthatofdeliveringhighquality,safeservices
thatmeettheneedsandexpectationsofourpatients
andthepopulationthatweserve.
TheTrusthasdevelopedaQualityImprovementPlan
whichoutlinesourqualityimprovementambition
overthenextfiveyears–improvingpatientsafety
byreducingavoidableharmandmortality.These
goalsarealignedwithdeliveryoftheCareQuality
CommissionImprovementPlaninyearone,andwith
ourQualityAccountandCQUINpriorities.Improving
patientexperienceisfundamentaltodeliveryofthe
QualityImprovementPlanandthiswillbefurther
developedandmonitoredthroughtheintroductionof
the‘IWantGreatCare’servicethroughouttheTrust.
Theimplementationofseven-dayworkingfor
non-electiveservicesisconsideredakeyenablerto
thedeliveryofhighqualityandefficientcare.During
2014/15plansarebeingdevelopedinordertofully
understandtheimplicationsandcostsassociatedwith
providingtheseservicesoversevendaysbothinhospital
andinthecommunity.Expandingservicesinthiswayis
integraltothesuccessfuldeliveryofbettercaretogether.
Therecruitmentandretentionofstaffremainsakey
strategicriskfortheTrustandhasbeenthefocus
ofsignificantworksince2013/14.Thefindings
oftheFrancisandBerwickreviews,aswellasthe
introductionofguidelinesfornursestaffinglevels
internallyandnationally,hasmaintainedthefocus
onthisarea.Wehave,asanorganisation,invested
intherecruitmentofmedicalandnursingstaff,a
strategywhichhasproventobelargelysuccessful.A
comprehensiveapproachtoworkforceplanningand
organisationaldevelopmenthasbeenimplemented
acrosstheTrustandislinkedtotheemergentservice
modelsbeingdevelopedaspartofbettercaretogether.
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Wehavedevelopedanestatesstrategythattakes
accountofthesubstantialcapitalinvestmentthat
isrequiredinordertoimproveclinicalefficiencies,
patientexperience,safetyandtheoverallenvironment
atourthreemainhospitalsites.Investmentinthe
estatewillhaveapositiveimpactonpatientandstaff
experienceaswellasimprovementsintheTrust’s
tradingposition.
In2013/14,weimprovedourfinancialpositionby
around£3minrealterms;ourinitialplansfor2014/15
forecastthatthistrendwouldcontinue,however
investmentinnurseandmedicalstaffing,andan
increaseinactivityhasmeantthishasnotbeen
realisedinthefirsthalfof2014/15.Asaresult,the
Trustcommencedafinancialrecoveryplanearlyin
theyear.
Thetransformationofourfinances,startingin2015/16
willbedrivenbycontinuedcostimprovementscombined
withapricingstrategyalignedtothenationalpricing
policyforTrustssuchasours.TheTrustsubmitted
aLocalPriceModificationapplicationtoMonitorin
September2014inlinewiththeguidanceavailable.
Thisapplicationiscurrentlybeingconsidered.
TheBoardofDirectorsfeelthatthismodeliskey
tosuccessfullymeetingthechallengesoftheNHS
nationallyandoftheuniquecharacteristicsofthe
geographyanddemographicsacrossMorecambeBay.
WeremainmindfulthattheNHSandLocalAuthority
partnersinNorthCumbriaandtherestofLancashire
arealsoundergoingchangesandwillcontinueto
workwithcolleaguesasourproposalsdevelopto
ensurethattheycomplementratherthancompete
withplanswithinthoselocalities.
Thesuccessfuldeliveryof‘bettercaretogether’,along
withtheTrust’sownCostImprovementProgramme
willresolvemost,butnotall,ofourfinancialdeficit.
Ourdetailedresearchandanalysishasshownthatthis
cannotbeachievedwithoutcuttingoutcoreservices
andwecannotrecommendthatasasafesolutionfor
localpeople.Ourplansdoprovideasolidplatformfor
ustobuilduponandwewillbeworkingwithNHS
Englandtoseekpoliticalsupporttoreviewtheway
thatfundingisallocatedtoreflectouruniquelocal
challenges.
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1. Overview
OverthelasttwoyearstheTrusthascontinuedto
makesustainableimprovementsinthedeliveryof
highqualityservicestopatientsthrough:significant
investmentinnursingandstaffinglevels,improved
governance,astrengthenedBoardandinvestment
inclinicalleadership.
TheTrustcontinuestoworkcloselywithkey
strategicpartnersacrosstheHealthEconomyon
theimplementationanddeliveryofthebettercare
togetherprogramme.
Untilthelocalhealtheconomysolutionisinplace,the
Trustwillcontinuetofacethefollowingchallenges:
•Thedeliveryofsustainable,highqualityclinical
services;
•ThedeliveryofafinanciallyviableacuteTrust;
•Recruitmentandretentionofstaff(capabilityand
capacity);
• Impendingincreasesinlocalhealthcaredemands.
Over next two years 14/15 to 15/16Asreflectedinthetwoyearoperationalplan,the
Trusthasplannedarobustprogrammeofactivityto
mitigateriskandensurethemaintenanceofhigh
qualitysustainableservicesforourlocalpopulation
untilbettercaretogetherisrealised.TheTrustwill
continuetobuildonanddeliver:
•Transformationalandtraditionalcostimprovement
programmes;
• Implementationanddeliveryofkeyservice
developmentsbuildingonthebettercareprinciples;
•Researchanddevelopmentportfolios;
•Aninnovativeapproachtorecruitment,workforce
andorganisationaldevelopment.
Withinourfirstphaseofservicedevelopments,and
inlineinwithbettercaretogether,wewillaimto
deliverarangeofservicedevelopmentsinpartnership
withourlocalcommissioners.Duringthetransition
period,from2016to2019,theTrustwillfocusonthe
implementationanddeliveryofthenewmodelsof
serviceasoutlinedinthebettercaretogetherstrategic
caseincluding:
•Outofhospitalmodel;
• Inhospitalserviceprovision;
•Thedevelopmentofnewmodelsofcaresuchas
IntegratedCoreTeams;
•Acutebasedservices–emergency/elective/
maternity;
•Potentialcommunityspecialistservices;
• Integratedmodelsofservicesjointlywith
communityservicesandsocialserviceswhichwill
allowaccesstotheBetterCarefund.
Section 1Executive summary
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1.1 Background
TheTrustprovidesacuteservicesfromfivesites,across
alargegeographicalareaservingasmall,dispersed
populationfocusedinthreemaincentresofpopulation
withsignificanthealthinequalitiesacrosstheregion.
Thelongtermstrategyforensuringfinancialand
clinicalsustainabilityistoundertakeareconfiguration
ofhealthandsocialcareacrossthebayarea.This
willbeachievedthroughthe‘bettercaretogether’
StrategywhichhasbeensubmittedtoMonitorand
NHSEnglandforconsiderationandcomment.
1.2 The trust’s current strategic risks
TheTrusthasidentifiedanumberofareasthatpresent
achallengetotheorganisationintheachievement
oftheTrust’sstrategicobjectivesandqualitygoals.
ThemainchallengesandriskthattheBoardare
respondingtoare:
•Deliveringsustainable,highqualityclinicalservices;
•Deliveringafinanciallyviablehealtheconomy;
•Deliveryofbettercaretogether;
•Recruitmentofstaff(capabilityandcapacity);
•Deliveryofseven-daynon-electiveservices;
•Effectivemanagementofnon-electivepatients
andsustainableachievementoftheemergency
carestandard;and
•Appropriateestates/environmentinwhichto
deliverservices.
Actionplansandprogrammesareinplaceto
mitigatetheserisks.Centraltotheseisthebetter
caretogetherStrategyandProgramme.TheTrust
anditspartnersacrossthelocalhealtheconomyhave
agreedaStrategythataimstodeliverafinancially
viablehealtheconomyandsustainable,highquality
primary,communityandacuteclinicalservices.The
preferredoptionwillseetheexpansionofprimary
andcommunityservicesleadingtoachangeinthe
provisionofacuteservicesbestsuitedtolocalneeds.
Accidentandemergencyservicesandconsultant-led
maternityunitswillberetainedatFurnessGeneral
HospitalandRoyalLancasterInfirmary.
ArevisedStrategywassubmittedtoMonitorandNHS
Englandon31October2014.TheTrusthasappointed
aBetterCareTogetherTransformationTeamthatwill
beresponsiblefordeliveringtheTrust’scontributionto
theoverallStrategy.
Itisunlikelythattherewillbesignificantchangesto
thestructureandoperationoftheTrustintheearly
partofthedeliveryofthebettercaretogetherStrategy
untilinvestmentsinprimaryandcommunityservices
havebeendelivered.InthemeantimetheTrustneeds
toremainfinanciallyandclinicallysustainable.
TheBoardhascommissionedexternalsupportto
assesstheimpactofgeographicandstructural
challengesinoursystems,whicharecontributingto
arecurrentfinancialdeficitpositionofcirca£35m
(currentforecast).Thisexternalreview,byPwC,has
shownthattheMorecambeBayhealthsystemhas
beenchallengedforsomeyears.Thereporthas
demonstrated:
•Theneedtoprovidehealthcaretoawidely
spreadpopulationrequiringmorehospitalsites
thanhealthsystemsofcomparativepopulation
size,withaconsequenthighercostsofprovision;
and
•Theimpactofstaffpremiums,oftenupto70%
higherthanthecostofNHSstaff,andthe
requirementtoaddressqualityissuesarisingfrom
regulatoryreviewsbytheCareQuality
CommissionandMonitor.
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TheimmediateresponseoftheBoardhasbeento
secureadditionalfundingfor2014/15fromthelocal
ClinicalCommissioningGroupsandNHSEngland.
For2015/16theBoardhasconsideredtheguidance
availablefromMonitorandhasmadeaformal
applicationforaLocalPriceModificationtorespond
totheimmediaterisksfacingtheTrust.
FollowingtheCareQualityCommissionHospital
InspectioninFebruary2014theBoardhasputinplace
anumberofmeasurestosustainandimprovequality
andperformanceoftheTrust,particularlyinrespect
ofCareQualityCommissionessentialstandardsand
harmfreecare.TheBoardhasapprovedaQuality
ImprovementPlandesignedtodeliverthelongerterm
qualityimprovementsneededoverthenextthree
years;theCareQualityCommissionImprovementPlan
willbeakeypartofthisinyearone.
TheCareQualityCommissionImprovementPlan
detailshowtheTrustwillsuccessfullyaddressthe
‘mustdo’and‘shoulddo’actionsidentifiedbythe
CareQualityCommissionfollowingitsinspectionof
theTrustinFebruary2014.
TheCareQualityCommissionImprovementPlanis
timelimited;ithastobe,astheTrustneedstodeliver
theimprovementsatagreaterpaceandbefore
ournextInspection.Toensuretheimprovements
canbesustainedandtotacklesomeofthelong
standingissuessuchasculture,weareestablishingan
‘ImprovementHub’toprovidesupportandassistance
toourstaff,helpingthemtofullyunderstandwhat
‘good’and‘outstanding’lookslikeandproviding
themwiththetoolstoachieveit.TheHubapproachwill
supportstafftousetriedandtestedtechniquesfor
deliveringconsistentchangesuchasListeningintoAction.
1.3 Estates strategy
TheTrustisdevelopinganEstatesStrategythatwill
deliveramoreeffectiveuseoftheTrust’sEstate.Itwill
seegreaterco-locationofrelatedservicesandrespond
tolongstandingissuesacrossourmainsiteswiththe
aimofimprovingefficiencyandthequalityofcare
andtreatment.TheStrategyisambitiousandwhilst
muchofitwillrequirecentralNHSsupporttheTrustis
planningtopressaheadwithanumberofimprovements
fromwithinitsexistingcapitalallocation.
1.4 Risk strategy
TheBoardhasrespondedtotherisksposedtothe
Trustbyfailuretorecruit,retainanddevelopstaffby:
•Developingworkforceplanstounderpinthe
reviewofvacanciesandmodelsofcarewithin
divisions,linkingtothemodelsofcareinthe
bettercaretogetherStrategy;
•TheExecutiveChiefNurseundertakingareviewof
nursingandmidwiferystaffing;
•TheTrustBoard,inautumn2014,agreedtoinvest
afurther£3millionintothenursingestablishment;
•RollingoutE-rosteringtoensurestaffaredeployed
wheretheyarerequired;
•Newrecruitmentstrategieshavebeenintroduced,
includingoverseasrecruitment,whichareproving
successful;
• Introducinganapprenticeshipschemetocreate
upto25newhealthcaresupportcadetsatboth
theFurnessGeneralandRoyalLancastersites;
•EstablishingaWorkforceAssuranceCommittee
oftheTrustBoardtooverseeworkforceissues
acrosstheTrust.
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ChallengesremaininensuringtheTrustcanmaintain
deliveryofbothelectiveandemergencypathways
effectivelyinmedicalandsurgicalspecialties.Divisions
haveundertakenagapanalysisagainsttheten
Keoghclinicalstandardsandwilldevelopaction
planstodeliversevendayservices,inlinewiththe
nationaltimetable.In2014/15,theTrustwillfocus
onemergencypathways.Sevendayworkingwillbe
incorporatedintothequalityrequirementsoftheNHS
standardcontractin2015/16and2016/17.Despite
sustainedimprovementintheperformanceofboth
ourEmergencyDepartmentsagainstthefourhour
target,maintainingthisstandardcontinuestobe
challengingastheTrusthasnotseenasignificant
reductioninthenumberofemergencyadmissions.
Therehasbeenanincreaseinambulanceattendances
andmanypatientsthatarepresentinghavemultiple
co-morbiditiesandgreateracuity;andthusahigher
levelofneed.Thelocalhealtheconomycontinuesto
worktogethertodevelopoperationalresilienceand
capacityplansandatthesametimetheTrustisdeveloping
additionalcapacitytomeettheincreaseddemand.
TheserisksaremanagedthroughtheTrust’s
governanceframeworkandperformancemanagement
structureswithassurancesonprogressreported
totheTrustBoardregularlythroughtheBoard
AssuranceFrameworkandtheCorporateRiskRegister.
AssurancesonprogressarereportedtotheTrust
BoardthroughtheFinance,WorkforceandQuality
Committees.Thesuccessfuldeliveryofthe‘better
caretogether’StrategyiscentraltotheTrust’slong
termplansforsustainability.Riskstodeliveryofthe
strategyincludethefailuretosecuresupportforthe
servicechangestrategy;potentiallyleadingtodelaysin
implementation.
1.5 Response to the regulator
ThebettercaretogetherStrategyistheoverarching
planforthelocalhealtheconomythatwillimpacton
theTrust.BeneaththistheTrusthasdevelopedaseries
ofstrategicplansthathavetheaimof:
•Delivering core business;
•Preparing for the impact of better care
together including developing activity
modelling and capacity for the Trust;
•Trust service development ambitions;
•Responding to the requirements of
the regulators.
Inaddition,thesestrategiesarenowbeingaligned
toreflectthenewvisionandvalues,aswellasthe
objectivesandprioritiesoftheTrustBoard.Themain
strategiesandplansareoutlinedwithintable1.
Table 1:
UHMBT strategic and operational plans 2014/15
•QualityImprovementPlan
•CQCImprovementPlan
•QualityAccount
•TwoYearOperationalPlan
• ITandInformaticsStrategy
•EstatesStrategy
• FinancialStrategy
•WorkforcePlans
•RiskManagementStrategy
•CodeofCorporateGovernance(underreview)
•DivisionalBusinessPlans
•CommercialStrategy(indevelopment)
•HealthandSafetyStrategy
•ResiliencePlanning
•PatientExperience
•CommunicationandEngagement(underreview)
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TheTrusthasbeenandremainssubjecttoanumber
ofregulatoryconcerns.TheTrustwasinspectedin
February2014aspartoftheCareQualityCommission
ChiefInspectorofHospitalInspections.Theinspection
highlightedanumberofimprovementareaswhichthe
Trustisrequiredtoaddress.MonitorplacedtheTrustin
specialmeasuresandattachedfurtherlicenceconditions.
TheChiefInspectormade15recommendationsin
total,eightofwhichtheTrust“must”undertakeand
sevenwhichtheTrust“should”undertake.All15
recommendationsareincludedinourCareQuality
CommissionImprovementPlan.Thekeythemesof
theserecommendationsaresummarisedbelow:
• Improvingourstaffinglevels;
•Engagingandcommunicatingmoreeffectively
withfrontlinestaff;
• Improvingperformanceinformationtodrive
improvementandgooddecisionmaking;
• Improvingournurserecordkeeping;
•Continuingtoimproveincidentreportingandthe
learningwegainfromincidents;
• Improvingtheavailabilityofcasenotesandtest
resultsinouroutpatientsdepartments.
TheTrusthassixconditionsattachedtoitsProvider
LicencebyMonitorandhasreceivedinspection
reportsfromtheCareQualityCommission,Ofsted
andtheHealthandSafetyExecutive.TheTrust
remainscommittedtoachievingcompliancewithits
providerlicencerequirementsandthatisreflectedin
itsstrategicplanningprocesses.InadditiontheTrust
developedaseriesofactionplanstoaddressthe
regulatoryconcernsraisedandprogressagainstthese
planswasandcontinuestobemonitoredbytheTrust
BoardanditsAssuranceCommittees.TheHealthand
SafetyExecutiveactionshavebeenundertakenand
signedoff(althoughtheHealthandSafetyExecutive
investigationisyettocomplete)andtheOfstedaction
hasalsobeenrespondedto.
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2. The local population health challenge
IndevelopingthebettercaretogetherStrategy,an
indepthanalysishasbeenundertakentoassessthe
healthneedsofourlocalpopulation,understand
futuredemographicchangesandhowweneedto
shapeservicesforthefuturetomeetthecompeting
healthcaredemandsandchanges.
TheMorecambeBayfootprintcoversalarge
geographicalarea,1,800km2,whichismorethan
doubletheareaforthenationalaveragetrustof
815km2.Conversely,thepopulationweserve,
365,000,islessthanthe418,000servedbyan
averagetrust.Thegeographicalfootprintposes
varyingchallengesincluding:
•Adiversepopulationwithindustrialurban
centressuchasBarrowinFurness,theuniversity
cityofLancasterandsmallisolatedvillages,
suchasOverKellet,HawksheadandConiston,
whichimpactsonthestructureanddelivery
ofhealthcare;
•Thelargegeographyandlowpopulation
densityhaveresultedinaconfiguration
ofhealthcaredeliverythatdoesnot
makeoptimaluseofestate
andotherresources.
Eachofthelocalitieshasitsownindividualhealth
needsandchallengesandservicesmustbedesigned
toimprovethehealthofourlocalpopulationsas
outlinedintable3.
Section 2Market assessment
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2.1 National and local guidance
Table 3: Local health population needs
Health needs CCG commissioning priorities
Population growth Life expectancy
Lancashire North
Prioritydiseaseareas:-•CVD•Cancer•COPD•Chroniccirrhosisof
theliver
Localpriorities:-•Toreducehealth
inequalities•Toreducepremature
deathsfromarangeofLTCs
Diseasesaffectingolderpeopleincluding:-•Dementia,circulatory
disease,diabetes,COPD,osteoarthritis,cancers.
Focuson:•Improvementin
strokeserviceprovision
•Improvingdementia
Higher than average predicted increaseintheproportionofolderpeopleinLancashireNorthovernext
10 years
1 year lower than national averagebutforthoseinthemostdeprivedareas:
Cumbria Prioritydiseaseareas:•Cancer•Cardiovascular
disease•Stroke•Respiratorydiseases
Localpriorities:•Reducinghealth
inequalities•Ensuringchildrenget
abetterstartinlife•Improvingmental
healthandwell-being•Supportinganageing
population
Toreduceavoidableunscheduledadmissionstohospitalforchildren
Toimproveclinicalqualityinthemanagementofstrokewithinthefirst30days
ImprovesupportforpatientstomanageLTCsfocusingonrespiratory
4.2%population growth over next 5 years
(comparedtothenationalaverage)inmostdeprivedareas
Furness AreasworsethantheEnglandaveragein2012:•22.7%ofadult
populationclassedasobese•Rateofalcohol
relatedharmhospitalstays
•Levelsofadultsmoking
Reducingalcoholmisuse
Reducingobesityinchildren
Reducingsmoking
Significant increase in >65yrs of
11.5%(comparedtothenationalaverage)inmostdeprivedareas
South Lakeland
1.ImprovinghealthandwellbeingofolderpeopleandthosewithDementia
2.Reducingroaddeathsandinjuries
3.ReducingalcoholSignificant increase in >65yrs of
16.7%
11.6 years lowerformen
6.4 years lowerforwomen
6.4 years lowerforwomen
9.6 years lowerformen
12 years lowerformen
9.9 years lowerforwomen
5.6 years lowerformen
4.8 years lowerforwomen
(comparedtothenationalaverage)inmostdeprivedareas
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AsaTrust,itisimperativethatwereflectnational
guidanceandlocalcommissioningplansinourstrategic
planningframework.
National guidance 2015/16ThenationalNHSplanningguidancefor2015-16
waspublishedinDecember2014.However,the
contractingandtariffguidanceisstillyettobe
finalisedandpublished.Indicationsarethat:
•TheNHSwillreceiveasingle-yearfinancial
settlementfor2015/16.Followingthegeneral
electioninMay2015,theincomingGovernment
willsetoutitslongertermprogrammeand
fundingplans;
•Theoverarchingobjectivesofthe2015/16
planningroundwillbetorefreshthesecondyear
ofexistingtwoyearoperationalplansand
establishafoundationforlongerterm
transformationbasedontheNHSFiveYear
ForwardView;
•ThereisaneedtosecurealignmentwithBetter
CareFund;
•TherewillbeanexpectationthatClinical
CommissioningGroupswillcontinuetheirworkto
implementtheirexistingfiveyearplans;and
•Emergingareasofchangeare:co-commissioning
ofprimarycare,futurecommissioningmodels
forspecialisedservicesandintroductionof
integratedpersonalcommissioning.
TheNHSFiveYearForwardViewguidance,published
inlateOctober2014,setsoutadirectionoftravel
whichiscompletelyalignedtotheTrustandourlocal
healtheconomy’svisionandambitionaroundthe
deliveryofthe`bettercaretogether’strategy.
Theguidanceoutlinedthefollowing:
•AcleardirectionfortheNHSoverthenextfive
yearsdiscussinghowthehealthserviceneedsto
change,whychangeisneededandhowthe
futuremightlook.Itarguesfor:amoreengaged
relationshipwithpatientsandcarers;settingup
ofpartnershipswithlocalcommunities,hard-
hittingapproachestomajorhealthriskssuchas
smokingandobesity;fordecisivestepstobe
takeninbreakingdownbarriersinhowcare
isprovided;theneedforcaretobedelivered
morelocallyandunderstandingthata‘onesize
fitsall’approachwillnotwork;theneedforcritical
decisionstobemadeoninvestmentandalsolocal
flexibilityinthewaypaymentrulesandregulatory
mechanismsareappliedtosupportrequiredchange;
•Theneedtogetseriousaboutpreventionof
avoidableillness;empoweringandsupporting
patientswithlongtermconditionsinmanaging
theirownhealth;
•Anumberofradicalcaremodelsaresuggested
inamoveawayfromthetraditionaldivide
betweenprimarycare,communityservicesand
hospitalserviceswiththedirectionoftravelbeing
tomanagenetworksofcare,expandand
strengthenoutofhospitalcare,integrateservices
aroundthepatient.Emergingmodelsinclude:
>MultispecialtyCommunityProviders(MCPs)
-thiswillpermitgroupsofGPsgroupsof
GPstocombinewithnurses,othercommunity
healthservices,hospitalspecialistsand
perhapsmentalhealthandsocialcareto
createintegratedout-of-hospitalcare.Care
couldbeofferedinafundamentallydifferent
way,makingfulleruseofdigitaltechnologies,
newskillsandroles,andofferinggreater
convenienceforpatients.Thisapproachaligns
tothevisiontheTrusthaswithkeypartners
forserviceprovisionaroundthe
Millomcommunity.
SummaryofourFiveYearStrategicPlan|2015-2020
15 A great place to be cared for; a great place to work.
>PrimaryandAcutecaresystems-combining
generalpracticeandhospitalservices,similar
toAccountableCareOrganisations.A
rangeofcontractingandorganisationalforms
arenowbeingusedtobetterintegratecare,
includinglead/primeprovidersandjointventures.
>UrgentandEmergencycarenetworks-
AcrosstheNHS,urgentandemergencycare
serviceswillberedesignedtointegrate
AccidentandEmergencydepartments,
GPout-of-hoursservices,urgentcarecentres,
NHS111,andambulanceservices.
>Viablesmallerhospitals-NHSEnglandand
Monitorwillworktogethertoconsider
whetheranyadjustmentsareneededtothe
NHSpaymentregimetoreflectthecosts
ofdeliveringsafeandefficientservicesfor
smallerprovidersrelativetolargerones.This
viewisinkeepingwithourapplicationfora
LocalPriceModificationtoreflectour
structuralcostsandthedeliveryoflocalservices.
AsanNHSfoundationtrustwewillplanfor:
•Changestothewayspecialisedservicesare
commissionedandtheimpactofthisonlocal
serviceprovisionandcommissioningarrangements;
•Changestothewayservicesarefundedandany
potentialimpactonservicedelivery;
•Changingcaremodels,includingintegrationwith
healthandsocialcareandhowthatwillimpacton
serviceswedeliver;
•Differentcommissioning/contractingmodels
proposalsandthepotentialforprimeprovider
models;
•ChangestoTariffguidanceandpaymentsystems;
includingemergencycare;and
•Potentialdecommissioningofcertainspecialised
services;followingthetransferofVascularservices
fromtheTrustfromApril2015.
2.2 Local financial challenges within Morecambe Bay
The ‘Bay-wide’ affordability gapThetotalhealthandsocialcarespendintheMorecambe
Bayhealthandcaresystemisover£500m.Wehave
ademographicandstructuralchallengeinoursystem
contributingtoafinancialdeficitof£25m-£30mwiththe
affordabilitygapprojectedtoriseto£71minfiveyears’
timeifwemaintainthestatusquo.Evenifallefficiency
targetsareachieved,therewillstillbearesidual,
recurringfinancialgapof£30minfiveyearstime,
whichwillcontinuetogrow.Asahealtheconomy,the
‘donothing’optionisnotfeasibleifwewishto
continuetoprovidehighqualityclinicalservicesfor
theourlocalpopulation.Overallhealthexpenditure
withinthelocalhealthsystemis£422m,excluding
relatedlocalauthorityexpenditure.Thelocalhealth
system’soverallfinancialpositionisfragileandthere
areincreasingpressuresoncommissionersaswellas
providerstoreducethefinancialgap.
Particular system wide themes that add to financial pressures are: •Theimpactofstaffpremiums,oftenupto70%
higherthanthecostofNHSstaff,andthe
requirementtoaddressqualityissuesarisingfrom
regulatoryreviewsbytheCareQuality
CommissionandMonitor;and
•TheCumbriahealthsystemisoneofelevenmost
challengednationally.
Thefinancialimpactofthesefactorsaddsfurther
pressuretothealreadyfinanciallyfragilehealthsystems
inMorecambeBayandacrossCumbriaasawhole.
Also,theneedforadditionalinvestmenttoaddress
backlogmaintenanceintheTrustisapressure.Capital
investmenthasbeensuppressedinrecentyearsasaway
ofaddressingfinancialandcashpressures.Thishasnot
onlyresultedinalackofday-to-daymaintenancewhich
nowneedstobedealtwith,butmoreimportantly,has
deferredchangestoclinicallayoutsandotherphysical
alterationsthatwouldhelpimproveserviceefficiency.
SummaryofourFiveYearStrategicPlan|2015-2020
16 A great place to be cared for; a great place to work.
Market AppraisalWehavemadesignificantinroadstoimprovethe
qualityandsafetyofourclinicalservicesforour
patients,andarecommittedtoaprogrammeof
improvementandservicedeliverywhichwillensure
thatweareequaltoifnotbetterthantheother
providerswithinthesurroundingareas.Outlined
belowisanassessmentofwheretheTrustsitsin
relationtolocalNHSproviders.
Table 5: Competitor performance analysis 2014
Data source UHMBTLancashire Teaching Hospitals Foundation Trust
NorthCumbria UniversityHospitals NHS Trust
Blackpool Teaching Hospitals Foundation Trust
Wrightington, Wigan and Leigh Foundation Trust
Note Monitor Enforcementaction;Specialmeasures
CQC InadequateRequiresImprovement
RequiresImprovement
TDASpecialmeasures(Keogh);Deficitof£27mProposedmerger
Governance Monitor Red Green N/A Green Green
TDA Poor
Continuityofservicesrating
Monitor 2 3 N/A 3 4
RTT(NHS 91.01% 80.39% 82.22% 91.96% 91.37%
England) 97.53% 95.37% 94.50% 96.81% 97.71%
Incomplete 95.50% 92.33% 90.99% 94.82% 94.21%
Cancer(NHSEngland)
2ww 94.79% 94.86% 93.72% 95.12% 98.66%
62Day 84.04% 81.95% 81.33% 87.04% 91.87%
A&E(NHSEngland)
A&EAttendances
95.12% 95.07% 94.12% 94.34% 95.71%
MRSABacteraemiaper100,000BedDays
HED 0.44 1.26 0.52 0.35 1.23
CDiffRateper100,000BedDays
HED 22.21 17.26 12.47 9.09 19.75
ElectiveOperationsCancelledatLastMinute
NHSEngland
538 675 475 541 358
SHMI HED* 104.07 104.27 93.62 115.9 104.33
*monthlySHMIdata,preInformationCentrerelease
Registration
SummaryofourFiveYearStrategicPlan|2015-2020
17 A great place to be cared for; a great place to work.
Our strengths and weaknessesAsanorganisationitisessentialthatweunderstand
ourstrengthsandweaknesses,enablingustoriseto
anychallengeinordertoprovidehighqualityservices
forourlocalpopulation.ASWOTanalysishasbeen
undertakenwhichidentifiesboththeopportunities
fortheTrustandthechallengesthatstillneedtobe
addressedandisoutlinedintable6.
Table 6: UHMBT SWOT analysis 2014
STRENGTHS WEAKNESSES OPPORTUNITIES THREATS
• NewBoardwithenhancedcapacityandcapability
• StrongclinicalengagementwithClinicalCommissioningGroups
• Clinicallyledoperationaldivisions
• Strongclinicalengagementinplanningandchangeprocess
• NewrobustGovernanceFramework
• OverallStableworkforce
• Corefinancialandassociatedsystemsarerobust
• NationalPatientSurveyresultscomparabletolocalcompetitors
• ImprovingEstatesandFacilities
• TheTrustrecognisestheveryseveredenttoitsreputationalimageasaresultofthepreviousfailingsinsafetyandquality
• Costsofoperatingonthreesites
• Needtoimprovebusinessintelligencecapabilitiestoimprovecorporate,operationalandclinicalperformance
• Furtherimprovementsincustomercareneededtoenhancepatientexperience
• Elective/nonelectivephysicalseparationduetolegacyestatesissues
• MorecambeBayclinicalstrategycouldprovidescopetoexpandtheprovisionofservicesalongthepathway
• Incomegainfromrepatriationofmorespecialistservicesandnewserviceareas
• JointworkingwithCCGsandotherpartnerstomaximiseestateutilisation
• Exploitationofnewtechnologye.g.Lorenzoelectronicpatientrecord
• PartnershipworkingwithotherTrustsonclinicalnetworksandsupportservicestoimprovesustainabilityandefficiency
• Plannedimprovementsinbusinessintelligencecapabilitytodriveequalityandefficiencybenefits
• ContinueworktoengageCouncilofGovernorsandFTMembersinthetransformationprocess
• Securinganagreementtoaclinicalstrategythatdeliverssustainableservicesinthemedium/longerterm
• Abilitytosecuretransitionalfinancialfundingtoallowforimplementationofclinicalstrategy.(MonitorlicenserequiresnoDHfundingbeyondMarch2014)
• Ensuringdeliveryofimprovementspermonitorlicenserequirements
• AnyQualifiedProvider–newprovidersenteringthemarketinlesscomplex/profitableareasofTrustbusiness
• FuturechangestoPBRtariffundernewregime
• Increasingtrendtospecialisationthroughspecialistcentresinmajorconurbationsresultinginlossofservices/incomee.g.vascular
SummaryofourFiveYearStrategicPlan|2015-2020
18 A great place to be cared for; a great place to work.
Commissioning IntentionsWorkingcloselywithourcommissioners,thedrive
forallcommissioningdecisionsfrom2014and
forthenextfiveto10yearsisthedeliveryand
implementationofthebettercaretogetherStrategy.
Thefootprintofthehospitalwillshiftandchange
astheoutofhospitalmodelsofservicestarttobe
embeddedonthenextstage.Workingcollaboratively
withcommissionersandpartnersacrosshealthand
socialcareisakeycommitmentfromtheTrust.
Diagram2showsthebettercaretogether
OutofHospitalModel.
However,thediversityofourlocalpopulationmeans
thattherewillbespecifichealthneedswhichourlocal
commissionerswillneedtofocuson.Abriefsummary
ofthelocalcommissioningintentionsishighlighted
below,allofwhichareimplicitwithinthebettercare
togetherStrategymodel.
CumbriaCommissioning IntentionsCumbriaCCG’scommissioningintentionsfocuson
fourkeyareas:Inequalities;ChildrenandYoungPeople;
MentalHealthandWellbeingandtheAgeingPopulation.
Intheshort-to-mediumtermCumbriaCCGhas
identifiedthefollowingkeypriorities:
•Reduceavoidable,unscheduledadmissionsto
hospitalforchildren;
• Improveclinicalqualityinthemanagementofa
strokewithinthefirst30days;
• Improvesupportforpatientstoself-managea
longtermcondition,focusingonrespiratory
illness.
Lancashire NorthCommissioning IntentionsLancashireNorthCCGhasidentifiedsixmajorstrategic
prioritiesfocusingonthemajorissuesfacingthe
healthofthelocalpopulationandwillworkwithits
partnerstoensurethatlocalhealthservicesaresafe,
sustainableandofhighqualityinlinewiththebetter
caretogetherStrategy.LancashireNorthCCGwillalso
haveaparticularfocuson:
• Improvementinstrokeserviceprovision;
• Improvingservicesforthosewithdementia;
• Improvingsupportforthosewhoprovidea
caringrole;
• Improvingservicesformilitaryveterans;
•Ensuringthatthehealthvisitorimplementation
planisimplemented.
SummaryofourFiveYearStrategicPlan|2015-2020
19 A great place to be cared for; a great place to work.
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SummaryofourFiveYearStrategicPlan|2015-2020
20 A great place to be cared for; a great place to work.
Our vision for health and care services across Morecambe Bay
By2025MorecambeBaywillhaveawell-deserved
reputationasoneofthebesthealthandcare
systemsintheworld.
Promotingwellbeingandpreventingillhealth
willbeourprimepurposewithmentalhealth,
children’s,andolderpeople’sservicesreceiving
equalprioritywithallotherareasofcare.
Workingherewillbeanexperiencethatattractshigh
performing,compassionatestaffwhoareasdrawnto
ourcultureofachievingexcellenceastheyaretothe
beautyandvarietyofourlandscape.
Specialistteams,includinghospitalconsultants,will
increasinglyworkinthecommunity,sharingtheir
expertisewithGPsandcommunityteams.Thesehealth
andcareprofessionalswillworkinapartnershipof
trustwithpatientsasequalstokeeppeoplefitand
well,Whenpeopleareilltheywillreceivehighquality
careandsupporttohelpthemtomanage
theirowncondition-mainlywithintheirownhomes
orlocalcommunity.
Ifpeopledoneedtogointohospitaltoreceivecare
theywillhaveconfidencethattheywillbetreatedwith
dignityandrespect.Theywillexpecttorecuperateat
ornearhome,freeingupacutehospitalbedsforthose
whoreallyneedthem.A&Edepartmentswillbeseen
asthelastratherthanthefirstportofcall.
Thefundingwereceivewillfairlyreflecttheneedsof
ourlocalpopulationsenablingustomakethebestuse
ofeveryNHSandSocialCarepound,meaningthatas
wellasmaintainingexistingserviceswecantake
advantageofnewtechnologyandadvancesin
medicineatanearlystagetoprovideevenbetter
outcomesforourpatients.
Peoplewilllivelongerandintermsoftheirhealthand
well-beingwillhaveabetterqualityoflifewherever
theylive,whatevertheirincome.Whenpeoplereach
theendoftheirlives,whereverpossiblethiswillbeat
homeinthecomfortoffamiliarsurroundingsorina
specialistplaceofcaresuchasanursinghomeorhospice.
Section 3The clinical model
SummaryofourFiveYearStrategicPlan|2015-2020
21 A great place to be cared for; a great place to work.
3.1 Overview TheTrust,inpartnershipwiththeClinical
CommissioningGroupsinCumbriaandNorth
Lancashire,hasbeenworkingtodevelopitsstrategic
visiontoachieveclinical,operationalandfinancial
stabilityforthelasttwoyearsthroughthebetter
caretogetherProgramme.Whilstinitiallyfocussing
onthechangethatcouldbedeliveredbytheTrustin
secondarycareservices,intheautumnof2013the
programmewasextendedtoincludeprovisionout
ofhospitalinthecommunity,primarycareandsocial
care.ThebettercaretogetherStrategydescribesthe
fiveyearstrategyforthefuturedeliveryofhealth
servicesacrossthelocalhealtheconomy,including
theacuteservicescurrentlyprovidedbytheTrustand
thoseoutofhospitalservicesprovidedbyourpartners.
Afundamentalprincipleunderpinningthebetter
caretogetherStrategyiscloserworkingbetween
thoseprovidingcareintheTrust(InHospitalservices),
andthoseprovidingcareinthecommunity(OutOf
Hospitalservices),toensurethatourpatientsreceive
therighttreatmentintherightenvironmentfortheir
needs.Awiderangeofcliniciansfromacrossthe
healtheconomy,includinghospitaldoctors,GPs,
nurses,midwivesandalliedhealthprofessionals,have
beeninvolvedin,andhavedriven,thedevelopmentof
theStrategyfromtheoutset.
Theactivitymodellingthathasbeenundertakenby
thebettercaretogetherprogrammeteam,supported
bytheTrust,predictsthatthisapproachwilldeliver
significantreductionsinthedemandplacedupon
hospitalbasedservicesinthefuture.Asaresult,
thebettercaretogetherStrategydescribesafuture
hospitalmodelwithfewerin-patientbeds,running
fewerout-patientclinics,but,importantly,retaining
emergencyandobstetriccareprovisionattheFurness
GeneralHospitalandRoyalLancasterInfirmary
sites.Inanumberofcasesitmaybeappropriateto
concentratesomespecialistproceduresononeortwo
ofoursitestoimprovethequalityofcareprovidedto
ourpatientsandimprovetheefficiencyofourservices.
Thetwoyeardeliveryplan,supportsthedeliveryofa
rangeofplannedcareservicesfromtheWestmorland
GeneralHospitalsite;thosepatientsrequiringcomplex
carewillcontinuetobeseenatFurnessGeneral
HospitalortheRoyalLancasterInfirmary.
Inordertosupportthedeliveryofthebettercare
togetherStrategyacrossthelocalhealthcommunity,
fourservicechangeworkstreamshavebeencreated:
•OutofHospital–SouthCumbria;
•OutofHospital–LancashireNorth;
•Womenandchildren’s;
•Plannedcare.
SummaryofourFiveYearStrategicPlan|2015-2020
22 A great place to be cared for; a great place to work.
3.2 In hospital
Afurtherworkstream,In-hospital,considerstheoverall
impactoftheproposalsfromtheservicechange
workstreamsontheTrusttoensurethattheimpact
ofalltheindividualschemes,includingtheTrust’sown
“businessasusual”efficiencyandcostimprovement
activities,whencombined,donotcompromisethe
operationalviabilityoftheTrust.Bymonitoringkey
performancemetricstheTrustwill,forexample,be
abletodemonstratethattheanticipatedactivity
reductionshavetakenplacetoenableittosafely
reduceitsbedbase.
Cliniciansandoperationalmanagersfromacrossthe
localhealthandsocialcareeconomyleadthese
workstreamsandhavesupportedthedevelopment
ofasystemwidetwoyeardeliveryplan.TheTrust
hasclinicalandoperationalrepresentationoneach
workstreamandourpartnersarerepresentedonthe
in-Hospitalgroup.TheTrust’sTwoyearOperational
Planlinksinextricablytothissystemwidedeliveryplan
outliningthekeybuildingblocksrequiredintheinitial
twoyearsofthisfiveyearstrategy.
3.3 Out of hospital
TheOutofHospitalmodelaimstoimprovecareand
patientexperience,keepingpeoplefitandwellfor
longerinthecommunity.Thedeliveryoftheoutof
hospitalmodelofcareacrossSouthCumbriaand
NorthLancashirewillbeimplementedinphases
throughIntegratedCare/PrimaryCareCommunity
teams,rapidresponseteamsandcarecoordination
centresthatbringtogetherstafffromprimarycare,
communityservicesandsocialcare.Asaresult,
activitythatdoesnotneedtobedeliveredinanacute
settingwillbemovedtoacommunitysetting.These
integratedteamsaredesignedtopreventattendance
atAccidentandEmergencythroughearlyintervention
andrapidresponse.TheywillalsoworkwiththeTrust
tofacilitatetheeffectivedischargeofpatientswho
aremedicallyfit.Theimpactofthesechangeswill
begintobeseeninyearoneofthedeliveryplanwith
theimpactincreasingthroughthefiveyearsofthe
Strategy.
3.4 Planned care
Theplannedcareworkstreamwilldesignandimplement
new,integrated,modelsofplannedcareacrossthe
localhealtheconomythatwilldeliverhighquality
serviceswhicharesustainableandmakethebest
useoftheresourcesavailable.Byenhancingthe
relationshipsbetweenprimaryandsecondarycare,
pathwayswillbecomemoreeffectiveandefficient
andpatientexperiencewillbeimproved.Thereare
threecoreareasofactivitywiththeplannedcare
workstream:Adviceandguidance,referralsupport
andclinicalpathwayredesign.
•Advice and guidance–enhancingdecisionmaking
inprimarycarebyprovidingaccesstoadviceand
guidancefromhospitalspecialists,thereby
ensuringappropriatetreatmentplansforpatients
andreducingunnecessaryappointments.
Thescheme,pilotedinNorthLancashirein2014,
wasnominatedforaHSJinnovationand
technologyaward.
•Clinical Pathway redesign–reducing
unnecessaryattendancestohospital,including
outpatientfollowups,throughincreasedpatient
managementinthecommunitybyspecialist
communityteamsandtheintegrationofclinical
services,resultinginabetterpatientexperience.
Theprogrammewillinitiallyfocusonfour
highvolumepathways:ophthalmology,cardiology,
musculoskeletalandrespiratory;followedby
gastroenterology,dermatologyandrheumatology
andurology.
•Referral Support Service–willprovideaccess
tospecialistAdviceandGuidanceanddiagnostic
investigationsforcommunitybasedhealth
professionalsthroughprofessionalsupportinthe
developmentofcarepathwaysacrossspecialities,
includingtheuseofdecisionaids.Theservicewill
actasthecentralrepositoryforclinicalpathway
informationforallthoseinvolvedinpatientcare.
Undertakingstructuredpeerreviewsofreferrals
forspecialistopinionandprovidingeducational
supporttolocalclinicalteams.
SummaryofourFiveYearStrategicPlan|2015-2020
23 A great place to be cared for; a great place to work.
3.5 Operational delivery for clinical divisions
TheTrusthasfiveclinicaldivisions:AcuteMedicine,
ElectiveMedicine,SurgeryandCriticalCare,Core
ClinicalServicesandWomenandChildren’s.Each
divisionalmanagementteamisledbyaClinical
DirectorsupportedbyaDivisionalGeneralManager
andanAssistantChiefNurse.
TheoperationalstrategyfortheTrust’sfiveclinical
divisionsisalignedtothedeliveryofthebettercare
togetherStrategy,theQualityImprovementPlanand
internalefficiency/costimprovementprogramme.
Anumberofcross-cuttingthemes,impactingonall
fivedivisions,havebeenidentifiedwhichreinforce
theneedforcollaborationacrossthelocalhealth
economy.Thekeystrategicaimscommontoallfive
clinicaldivisionsare:
•Developing,recruitingandretainingaworkforce
whichsharestheTrustvaluesanddeliverscarein
linewithourobjectives;
•Engagingourworkforcethroughinitiativessuchas
ListeningintoAction;
•Developingourestatesothatitisfitforpurpose
andabletosupportthedeliveryof21stcentury
careinanefficientandeffectiveway;
•DeliveringthetenKeoghstandards;
•DeliveringtherecommendationsoftheFrancis
andBerwickreviewreports;
•Supportingthedevelopmentoftechnology
toimprovepatientcarethrough,forexample,the
deliveryofthePaperlitestrategywhichaimsto
deliver80%ofoutpatientconsultationswith
anElectronicPatientRecordratherthanpaper-
basedmedicalnotes,andenableremotereporting
fordiagnosticfilms;
•Providinganefficientoutpatientservicethatdelivers
highqualityclinicaloutcomesandapositive
patientexperience;and
• Furtherdevelopingtheethosofanevidence-based
approachtoclinicalpracticeandanexpansionof
ourportfolioofeducationandresearch.
SummaryofourFiveYearStrategicPlan|2015-2020
24 A great place to be cared for; a great place to work.
Asummaryoftheplansforeachdivisionareshownin
thetablesbelow:
Table 8: Core clinical services division(IncorporatingTherapyServices,Pharmacy,Diagnostics,OutpatientServicesandMedicalRecords)
Scheme Year of Plan better care together workstream
Outpatientimprovementplansfocussedonimprovingpatientexperience
2014-2017 PlannedCare
ProvisionofRadiologyservicesthroughamanagedservicecontract,sharingriskandimprovingtheviabilityofalocalserviceforpatients
2015-2016 N/A
ProvisionofPharmacyoutpatientdispensingthroughanoutsourcedmodeltofacilitatethedeliveryofsaferandmoreeffectivemedicinesmanagementbyTrustPharmacistsforpatientsrequiringastayinhospital;theseareoftenthesickestpatientswiththehighestcarerequirements.
2015-2017 InHospital
RedesignofPathologyservicestoensuregreatestefficiencyandsafetywhilstsupportingthedeliveryoflocalcare.
2015-2017 PlannedCareInHospital
Become“theprovider”ofcommunitytherapyservices,providingservicestothecommunitiesofSouthCumbriaandNorthLancashire.AlliedHealthProfessionscurrentlyprovidearangeofservicesacrosshospitalandcommunitycare.
2016-2017 OutofHospitalPlannedCare
SummaryofourFiveYearStrategicPlan|2015-2020
25 A great place to be cared for; a great place to work.
Table 9: Surgery and critical care division(Incorporatingtheatres,adultcriticalcare,anaesthetics,orthopaedics,headandneckservices,generalsurgery,breastsurgery,ophthalmologyandurology.
Scheme Year of Plan better care together workstream
CentralisingemergencyENTandUrologyServices 2015-2016 InHospital
Managingcapacityanddemandthroughtherolloutofthe“GOOROO”systemincludingforecastscapacityrequirementsbasedonreferrallevels
InHospital
Musculoskeletalclinicalpathwayredesign 2015-2016 PlannedCare
Ophthalmologyplannedcareclinicalpathwayredesign
2015-2016 PlannedCare
Urologyclinicalpathwayredesign 2015-2016 PlannedCare
SupportingtheconsolidationofspecialistvascularservicesincludingtheredesignofGeneralSurgerytofacilitateanewmodelofservicedelivery
2015N/A:partofSpecialistCommissioningplansforvascularservices.
Redesigningpathwaystosupportdeliveryofincreasedoutpatientprocedures
2015–2016 PlannedCare
Redesigningpathwaystosupportthedeliveryofmoreproceduresasdaycases
2015–2016 PlannedCare
Continuingdevelopmentofmacularservicestosupportthegrowthindemandasaresultofanageingdemographyandtechnologicaladvancesinthetreatmentofthesedebilitatingeyeconditions
2015-2017 PlannedCareWorkstream
SummaryofourFiveYearStrategicPlan|2015-2020
26 A great place to be cared for; a great place to work.
Table 10: Women and children’s division(Incorporatingobstetrics,gynaecology,maternityandpaediatricservices)
Scheme Year of Plan better care together workstream
RespondingtotheMorecambeBayInvestigationrecommendations
2015-2016 WomenandChildren’s
Provisionofcommunitypaediatricservices 2015-2017 WomenandChildren’s
Supportingthedeliveryofthebettercaretogether“stakesintheground”commitmenttoobstetricunitsatFurnessGeneralHospitalandtheRoyalLancasterInfirmaryandamidwife-ledbirthcentresupportedbycommunitymidwivesatHelmeChase,Kendal.
2015-2016 WomenandChildren’s
DevelopourImprovementPartnerModel(startingwithmaternity)tosupportthedeliveryofsafe,sustainable,highqualityservices
2015-2017 WomenandChildren’s
Table 11: Elective medicine divisionIncorporatingrheumatology,dermatology,gastroenterology,oncology,haematology,respiratoryandcardiology)
Scheme Year of Plan better care together workstream
Expandingtheworkforcetobalancecapacityanddemand,whilstsupportingthepathwayredesign
2015-2017 PlannedCareOutofHospital
Supportingthedeliveryofadviceandguidance 2015-2016 PlannedCare
Redesigningclinicalpathwaysforrespiratory 2015-2016 PlannedCare
Redesigningclinicalpathwaysforcardiology
2015-2016 PlannedCare
Redesigningclinicalpathwaysfordermatology 2016-2017 PlannedCare
Redesigningofclinicalpathwaysforgastroenterology
2016-2017 PlannedCare
Redesigningofclinicalpathwaysforrheumatology 2016-2017 PlannedCare
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Table 12: Acute medicine division(IncorporatingEmergencyDepartment,ElderlyCare,AcuteMedicalUnitsandalldownstreammedicalwards)
Scheme Year of Plan better care together workstream
SustainablydeliveringEmergencyDepartmentqualitystandards
2015-2017 InHospital
Supportingthedeliveryofoutofhospitalcaretoreducedemandsonacuteservicesthroughavoidanceofadmissionsandearlierdischarge
2015-2017InHospitalOutofHospital
DeliveringEarlySupported.DischargeforthepopulationsofSouthCumbriaandNorthLancashire
2015-2016 OutofHospital
RedesigningFrailElderlypathwaystoimprovethequalityofcareandreducemortality,unnecessaryadmissionsandavoidreadmissions
2015-2017 InHospitalWork
RedesigningtheurgentfloorandEmergencyCareatFurnessGeneralHospital
2015-2016InHospital;WorkstreamOutofHospital
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4.1 Overview
OurambitionisforUHMBTtobe:
“A great place to be cared for; a great place to work.”
Webelievethiscanonlybeachievedthroughthe
developmentofaflexible,highlyskilled,motivated
andengagedworkforce.
ThebettercaretogetherStrategyoutlinesthescale
ofchangefacingourhospitalsoverthenextfive
yearsandthis,alongsideourchallengingfinancial
environmentandourdrivetoimprovequality
standards,meansthatitisessentialthatwedevelopa
workforcestrategythatwilladdressthesechallenges..
TheoverarchingaimsoftheWorkforceStrategyareto:
•Developaflexible,highlyskilled,motivatedand
engagedworkforcethatisabletodeliverthe
Trust’svision,mission,valuesandobjectives;
•Buildonourstrengths;
• Fundamentallyaddressourareasfordevelopment;
•Deliveragainsttheworkforcechangesthatare
requiredoverthenext5years.
4.2 Workforce Strategy components
Overthenextfiveyears,thekeycomponentsofthe
workforcestrategywillbeto:
1.Developarobustworkforceplantosupport
deliveryoftheTrustStrategyandthelocalhealth
economy’sbettercaretogetherStrategy;
2.DevelopaworkforceabletodeliverourQuality
ImprovementPlan;
3.Createagreatplacetoworkthatensuresagreat
placetobecaredfor;
4.Createtherightconditionstoattractandretain
thebestpeoplethroughefficient,effectiveand
valuebasedrecruitmentunderpinnedby
continuousdevelopmentprocesses;
5.Createanenvironmentwhereallstafffeelhealthy,
happyandsafe;
6.Createaplatformforinnovation,changeand
improvementwherestaffareactivelysupported
throughchangeprocesseswithinacultureof
continuousimprovement;
7.Createacultureofengagementwhereallstaffare
activelyinvolvedinthedecisions
thataffectthemandtheservicetheyprovide;
8.Createthespaceandsupportiveenvironments
forallstafftoreachtheirfullpotential,toenable
themtomakeapositivecontributiontochanging
organisationallandscapes;
9.Createamodern,‘fitforpurpose’HRservicethat
addsvaluetothebottomline.
Section 4Workforce and organisation development strategy
SummaryofourFiveYearStrategicPlan|2015-2020
29 A great place to be cared for; a great place to work.
Progressagainsttheseninecomponentsofthe
WorkforceStrategy,willbemonitoredthrough
DivisionalQuarterlyPerformanceReviews,the
WorkforceandAssuranceCommitteetoTrustBoard.
4.3 Creating a culture of improvement
AkeyfocusoftheWorkforceStrategyistobuildand
embedanorganisationalculturefocusedondelivering
agreatplacetobecaredfor;agreatplacetowork.
Recognisingthatconsistentlyexcellentpatientservices
willonlybedeliveredwherethereisaframeworkofour
vision,valuesandbehaviours,settingoutwhatwestand
forasaTrustwewillsetouttheattitude/behaviours
thatourpatientsshouldexpectfromallourstaff.
Webelievewearejudgedbyhowweactandthatour
reputationisdefinedbyhowwedeliveragainstour
visionandputintopracticeourcorevalues.OurVision&Values
SummaryofourFiveYearStrategicPlan|2015-2020
30 A great place to be cared for; a great place to work.
Listening into Action
WehaveintroducedListeningintoActionandan
ImprovementHubtosupportthedevelopmentof
patient-centred,safety-focussedorganisationalculture,
builtaroundpatientsreceivinghighquality,effective
servicesfromcompassionate,caringandcommittedstaff.
Ifwearetodevelopaculturethatisinstantlyrecognisable
asanemployerwhodeliversagainstitsvisionand
values,thenweneedtodevelopaworkforcethat
deliverstherightcare,intherightplaceattheright
time,withtherightbehaviourstodeliverexcellence
everytime.
Wewillcontinuetoreviewourapproachto
recruitmentandretention,workingwithlocalpartner
organisationstoinvestinthelocalcommunity
providingopportunitiesforlearning,developmentand
employment.
WewillseektooptimiseourUniversityHospitalsstatus,
growingourresearchandeducationalportfoliosto
ensureweareabletorecruit,developandretainthe
clinicalstafftodeliverthehealthcareneedsofour
population.
Fromhowwetreatourpatientsorgoaboutour
businesswithcolleagues,staff,governorsandpartners,
ouractionswillalwaysbegovernedbyourvalues.
4.4 Workforce profile
The Trust currentlydirectly employs
4,983staff(4,218.7wte).
ThisexcludesbankstaffandthosedoctorsintrainingemployedbyPennineAcuteHospitalsNHSTrust.
Over the last three years, the Trust has invested nearly
£8mofadditionalresourceinmedical,nursingand
midwiferystaffingresultingin
25 more doctors
71 more registered nurses
11 more registered midwives
whencomparedtoApril2012.
Inaddition,asaresultoftheintroductionof“redrules”the Trust has made a commitment to invest a further
£3min front-line nursing staff based on clinical priorities.
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Developing our workforce
Successfulrecruitmentofqualifiednursingand
midwiferystaffhasseenthevacancyratesteadily
reducingwithresidualvacancylevelsoftenbelow
nationalaverage.However,recruitmenttofrontline
clinicalstaffcontinuestobeahighriskfortheTrust
andwewillcontinuewithongoinglocal,national
andinternationalrecruitmentdrives,supplemented
bydevelopinginnovativeworkforcesolutionswith
partnerorganisations,includingotherhealthcare
providersandacademicinstitutions.
Despitenationalshortagesinanumberofspecialties
wehavemadesuccessfulappointmentsin
Gastroenterology,Anaesthetics,Cardiology,Radiology
andHistopathology.Anumberofhard-to-fillConsultant
postsinrecognisednationalshortagespecialtiesremain.
TheTrustwillcontinueitsapproachtocreatingand
expandingthedevelopmentofnewroles,suchas
ConsultantRadiographers/Sonographers,Advanced
PractitionersandPhysicianAssociates.Thebettercare
togetherStrategywillcreateopportunitiesforcross-
organisationalroledevelopmentwhichwewillexploit
inordertocreateinnovativenewpoststoattractand
retainclinicianswiththeskillsrequiredtomeetthe
healthcareneedsofthelocalpopulation.
Theageprofileofourworkforceissuchthatapproximately
25%ofourregisterednurses,33%ofourmedical
anddentalstaffandunregisterednursingworkforce
areaged51orabovewithalmost50%ofourEstates
staffalsofallingintothiscategory.Ourrecruitment
planswilladdressthisbutourlongtermplansalso
centreongrowingasustainableworkforcelocally.
TheintroductionoftheClinicalHealthcareApprenticeship
(DiplomaLevel3)inFebruary2015isthefirststep
intheprocesswiththefirstcohortof50apprentices
startinginFebruary2015.
Apprenticeshipsarealsobeingdevelopedinsupport
servicefunctions,commencingwithEstates
apprenticeshipsin2014.
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32 A great place to be cared for; a great place to work.
4.6 Attendance managementWhilsttheTrust’ssicknessabsencerateisatthe
North-Westaverageforacutehospitals,itis
significantlyabovethenationalaspirationaltargetof
3.4%.Sicknessabsenceisestimatedtocostaround
£5mperannumindirectcostsalone.
TheTrust’sforwardfocusisaboutcreatingapositive
employmentculture,“agreatplacetowork”.Central
tothisisthedevelopmentofapositiveattendance
managementculture,wherestafffeelvaluedand
appreciatedfortheircontributionatwork.
Whilstitisclearthatsicknessabsenceneedsto
bemanagedmoreeffectivelyandappropriately,
recognisingandrewardinggoodattendanceisevery
bitasimportantasitwillcreateanenvironmentwhere
peoplewanttocometowork.
4.7 Contingent staffing
TheTrusthas,historically,operatedonthebasisthat
short-termstaffingrequirementswhichcannotbemet
fromwithinexistingstaffingresourcesoraninternal
bankarrangementareprovidedthroughtheuseof
agencyworkers.
In2013/14theTrustspentatotalof£16.4millionon
agencystaff,£13.6mofwhichrelatedtomedicaland
nursingstaff.Table13showsthecurrentposition.
Spendtodatehasincreasedby£1.5monthesame
periodlastyear:
Futureplansarebasedondevelopingamoresustainable
approachtocontingentstaffing,byconvertinglong-
standingcontingentspendintosubstantiveposts.
Whilsttherewillalwaysbeaneedforcontingentstaff
tocovercriticalvacanciesandunforeseenabsence
thereshouldbelessrelianceonagencystafftoprovide
corebusinessactivityonanongoingbasis.
Wewillreviewouruseofcontingentstaffsuppliers,
consolidatingwherepossibleinordertoensureoptimum
useismadeofcontingentstaffingarrangements.
4.8 Staff engagement
Thedeliveryofconsistentlyexcellentpatient
experienceisreliantuponanengaged,competent
andmotivatedworkforce,unifiedbyacompelling
organisationalculturebuiltaroundpatient-centred
andsafety-focussedcare.Thecommitmentto
staffengagementisenshrinedwithintheNHS
Constitutionalpledge:togiveeveryemployeethe
opportunitytobeinvolvedindecisionsthataffect
themandtheservicesthattheyprovide.
TheintroductionofListeningintoActionandthe
ImprovementHubwillcontinuethedrivetogiveall
ourstaffanincreasedvoiceonhowtheTrustcanbe
improvedandencouragethemtopersonallytake
actiontoachievethis.
Weknowthatittakestimetoachievethecultural
changewerequire;timetochangethewaypeople
think,actandbehaveinanorganisation.Wewillmonitor
ourprogressthroughtheannualNHSStaffSurvey.The
2013/14results,ourbaseline,areshownintable14. Table 13: Agency and locum staff spend
2013/14£m
2013/14%
2014/15(ytd)£m
2014/15(ytd)%
MedicalLocums
11.1 81.6 6.4 77.1
NursingAgency
2.5 18.4 1.9 22.9
Total 13.6 100 8.3 100
Table 14: UHMBT saff survey results 2013/14
Achievement Number %
Best20% 11.1 14%
Betterthanaverage 2.5 7%
Average 13.6 11%
Worsethanaverage 12 43%
Worst20% 7 25%
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33 A great place to be cared for; a great place to work.
Whilstwewanttoimprovestaffexperienceoverall
ourkeyimprovementareasare:
Indicator 2013/14 Score
Staffabilitytocontributeto 65%
improvementsatwork
StaffrecommendationoftheTrust3.39outof5
asaplacetoworkor
receivetreatment
Staffmotivationatwork 3.76outof5
Ourambitionistoshifttheparadigmaroundstaff
experienceandengagement.Withinfiveyearswe
wantourstaffsurveyresultstodemonstratethat
60%oftheKeyResultAreasfallwithinthe
‘BetterthanAverage/Best’20%categories.
4.9 HR Cornerstones
Inordertodelivertheoverarchingworkforce
developmentandorganisationaldevelopmentplan,
sevencornerstoneprojectshavebeendeveloped
aroundthekeyelementsoftheemployeelife-cycle:
•Modernise
•Proposition
•Entry
•Wellbeing
•Transform
•Engage
•Raise
EachprojectisledbyaseniormemberoftheWorkforce
andOrganisationalDevelopmentteamwithprogress
monitoredbytheWorkforceCommittee.Each
cornerstoneprojectlinksdirectlytothecomponent
partsoftheworkforcestrategydescribedabove.
4.10 Improvement Hub
Inorderfortransformationalchangeandcontinual
improvementtotakeplaceacrossourorganisation
thereisaneedfortheTrusttobecomealearning
organisation:forimprovementandinnovationto
becomepartofeveryone’srole,andtobeconsidered
partofthedayjobi.e.partoftheculture,ortheway
wedothingsaroundhere,istocontinuallylookfor,
andimplement,improvements.AnImprovementHub
willprovideanorganisationalfocusforthis.
Our Improvement Hub will comprisethe following elements:
•Quality Improvement Panel(multi-disciplinary
andwithExecutiverepresentation)
• Improvement Team,headedbyanImprovement
Lead,providingoperationalleadershipandfocus
•Local Improvement Champions,toleadonlocal
improvementprojects.Theseindividualswill
receivetraininginimprovementscienceand
methodologiesandcoachingsupportasneeded.
•Local Improvement Teamstoensurea
multi-disciplinaryteambasedapproachto
improvement,maximisingstaffengagement.
•Academic partner(s)toprovidetraining
andexpertiseinimprovementmethodologies
andcoaching/facilitationsupporttoproject
groups.Academicinputtodeveloprobust
performancemeasurestomeasureand
monitorsuccess.
•NHS Partner/buddy organisation(s)toprovide
expertise,experienceandtovalidateourapproach.
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34 A great place to be cared for; a great place to work.
4.11 Listening into Action
ListeningintoActionisanevidence-basedwayof
workingwhichhasledtoimprovementsforpatients
andstaffinotherNHSTrusts.TheTrustsignedup
toListeningintoActioninSeptember2014,itis
akeymeansthroughwhichwewillimproveour
organisationalculture.
ThefirstyearofListeningintoActionwillsee:
•ahighprofileroundofstaff“BigConversations”
designedtogenerateanunprecedentedviewof
‘whatmatterstostaff’;
•aseriesof‘bigimpact’actionsinresponsetothe
“BigConversations”;and
• supportforthefirst10‘ontheground’toadopt
ListeningintoAction,followedbythenext
20teams.
ListeningintoActionisakeyvehicleforengagingall
therightpeopleinthepositivechangestheywantto
see,givingthempermissiontodeliverwiththefull
supportandbackingoftheTrust.
4.12 Hard Truths
AspartoftheHardTruthsreportrecommendations,
wepublishdatarelatingtonursestaffinglevelson
amonthlybasis.Wecontinuetoreviewourward
establishmentsandusethesaferstaffingtooltoassess
acuityacrossanumberofourwards.
WardInformationBoardsaredisplayedpublically
aroundoursitesandthesecontainlocalinformation
onstaffinglevels.Wehavemadesignificant
improvementsinournursestaffinglevels,butwe
stillhavemoreworktodotoensurethatwehave
therightnumbersandskillmixacrossallshifts.
4.13 Safe staffing and Red Rules
Inthepastyear,therehavebeenanumberofnational
reportsandrecommendationsrelatingtonursingand
midwiferystaffingandskillmix.TheTrusthasalsobeen
carryingoutitsownworktomakesureournurse
staffingismapped,notonlytothenumberofpatients,
butalsothecomplexityofeachindividual’sneeds.
‘RedRules’havebeenintroducedtoensuresafe
staffinglevelsonourwards.Theseincludeanescalation
processwherewhenstaffinglevelsfallshortofthese
toensurepromptactionistaken.Tosupportthis
morerigorousstandardofnursingcare,theBoardhas
recentlyapproved,inprinciple,over£3mtorecruit
additionalregisterednurses.
Wearenowintheprocessofworkingwithpartners
tolookatwaystosecureadditionalfundingandare
takingallstepstoensurewemeetandexceedthecare
standardsourpatientsdeserve.
4.14 E-rostering OurE-rosteringProjectisakeyenablerinthe
assuranceofsaferstaffingandtheefficiencyand
effectivenessofournursingteams.Roll-outacrossall
nursingareasisdueforcompletionbyJanuary2015.
Thesystemalsohasthepotentialtoallowactive
monitoringofstaffinglevelsagainstpatientacuityin
real-time.Itisourambitiontoextendedtheuseof
E-rosteringacrossotherstaffgroups.
Whenfullyimplementedthesystemwillprovide
aviewonreal-timeworkforceutilisationthathas
notbeenpreviouslybeenavailable,whichwilldrive
betteruseoftheworkforceandmoreinformed
investmentdecisions.
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35 A great place to be cared for; a great place to work.
4.15 How our workforce needs to change
Thekeyworkforcecharacteristicsthatneedtochange
overthenextfiveyearsareoutlinedbelow:
Table 15:
Changing workforce profile
Workforce in 2014 Workforce in 2019
Hospitalbased Careclosertohome
inarangeofsettings
Reactiveworkforceplanning Integratedandclinically-
agreedshort,medium
andlongterm
workforceplans
Servicesattimesandplaces Servicesattimes
thatsuitstaff andplacesthatsuit
patients
Lessefficient Moreefficient
Lessengaged Moreengaged
Staffareawareofour Allstaffareawareof
trustvalues andareproudto
deliverourtrustvalues
4.16 The impact of better care together
Theproposedmodelsofcarereferredtowithinthe
bettercaretogetherStrategyhighlightanumberof
workforceconsiderations.Areviewofthemodelhas
beenundertakentoassessthehigh-levelimpactthat
thebettercaretogetherStrategywillhaveonthe
in-hospitalworkforce,basedupontheassumed
activityshiftswithintheStrategy.
Itisanticipatedthatactualrealisedstaffingreductions
asaresultoftheactivityreductionsinbettercare
togetherandassociatedchangestowaysofworking
mayresultinfewerhospitaljobsbeingneededinthe
future–althoughweexpectanyreductiontobemet
bypeopleretiringandreducingthenumberofagency
staff.
Overthe5-yearperiodoftheinitialstrategy,these
workforcecalculationssuggestthatitisunlikely
thattherewillbeasurplusofstaffavailablefrom
thein-hospitalworkforcetosupportthedeliveryof
theOutofHospitalmodelsofcaredescribedwithin
thebettercaretogetherStrategy,whichequatesto
approximately240wteadditionalstaff(although
thesenumbersaresubjecttofurtherrefinement).
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36 A great place to be cared for; a great place to work.
ThebettercaretogetherStrategythereforepresents
theTrustandthelocalhealthandsocialcareeconomy
withtheopportunitytodesignandinvestinanew,
modernout-of-hospitalworkforcethathastheflexibility
andagilitytodelivercareclosertopatients’homes.
Thiswillrequirethedevelopmentofa‘system-wide’
attraction,recruitmentandretentionstrategythat:
•overtime,reducesinvestmentinthein-hospital
workforcesoastoallowgreaterinvestmentinthe
out-of-hospitalworkforce
• continuestoattractnewstaffvialocal,national
andinternationalrecruitment
•protectsexistingservicesfromde-stabilisation
duringperiodsoftransition
•minimisesany‘doublerunning’ofservices
Inordertosupporttheattraction,retentionand
recruitmentofstaff,therewillalsobearequirementto
developaneducationandtrainingstrategythatwill
enablenewandexistingstafffromacrossthelocalhealth
economytoeffectivelycarryouttheout-of-hospital
rolesdescribedwithinthebettercaretogetherStrategy.
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37 A great place to be cared for; a great place to work.
5.1 The impact of better care together
TheTrust’sEstatesStrategycomprisesthreedistinct
elements:
1Backlogmaintenanceandequipmentreplacement
schemes–businessasusual;
2Schemestosupportdeliveryofthebettercare
togetherStrategy;and
3Capitalschemesdesignedtoaddressoldand
inefficientestate,particularlyattheRoyal
LancasterInfirmary.Theseplanswould
improveclinicalco-locationandalloweffective
patientflow;improvingtheexperienceofour
patients:improvinginfectionpreventionand
efficiency.Theseplanshavebeendeveloped
overan8-10yearperiod;however,thisstrategy
isfocusedonyears1-5.
Ourestateimprovementplansarefocused,
predominately,attheRoyalLancaster
InfirmaryandatFurnessGeneral
Hospital.Theycanbedeveloped
indiscretephasesandtheir
implementationcanbeflexed
toreflectchangestothe
deliveryoftheactivity
reductionswithin
thebettercare
togetherStrategy
ifrequired.
Royal Lancaster Infirmary
•MajorexpansionofthecoreCentenaryBuilding
attheRoyalLancasterInfirmarytoaccommodate
allclinicalareastherebyallowingdemolitionof
unsuitablespaceontheLancastersite.Eachphase
oftheexpansioncanbebuiltandcommissioned
separatelywhichenablestheTrusttoretain
flexibilitytoaccommodateanychangestoactivity;
•EnhancementoftheTrust’seducationalrolewitha
largerEducationCentre,andconcentrationof
non-clinicalandadministrativeuseswithina
refurbishmentoftheGradeIIlistedbuildingatthe
frontoftheRoyalLancasterInfirmarysite.
Diagram 4:
Provisional illustrations for the expanded Royal
Lancaster Infirmary
Section 5Estates strategy
ExpandedCentenary Building New multi-storey
car park for staff and visitors
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38 A great place to be cared for; a great place to work.
Furness General Hospital
•Changeswillbemadetothecurrentclinicalspace
withinFurnessGeneralHospitaltoimprove
theflowofpatientsthroughclinicalunitsthrough
relocatingsomeservicesandrationalisinga
numberofothers.
Acrossallofoursiteswewilllooktoensurethatour
clinicalcapacityislocatedinthemostappropriate
placetofacilitatethedeliveryofthebettercare
togetherStrategy.Wewillupgradeourheating
systemsandenergyinfrastructuretoimprove
efficiency,reducerevenuecostsandcontributeto
nationalcarbonreductiontargets.
5.2 Business as usual
TheTrusthasacapitalbudgetofapproximately
£8.5millionperannum.
Capitalfundinghasbeenlimitedforanumberofyears
anditiscalculatedthat£59misrequiredtobringour
estateuptoERICstandard-conditionB.Theadditional
fundingrequiredtoprovidetemporaryclinicalareas,
suchastemporarywardsandtheatres,whilstthiswork
wastakingplaceisestimatedat£67million.Ifthebacklog
maintenanceiscarriedout,thisworkaspartofamore
comprehensiveestatesimprovementplan,wouldresult
inthebacklogcostsbeingreducedtoapproximately
£42million.
5.3 Latest equipment
TheTrusthasidentifiedanumberofitemsofmedical
equipmentthatareoperatingbeyondtheirnormal
life.Areplacementplanhasbeendevelopedtoallow
spendtobeprioritisedwithfundingof£25mrequired
overthefiveyearperiod.
Energyefficiencieswillbeachievedthrougha
programmetodesignandfinancearound£5mof
investment.
5.4 Impact of better care together
Anumberofelementsofthebettercaretogether
capitalprogrammecanbeachievedandimplemented
withouttheneedfortheadditionalinvestmentoutlined
withintheTrust’sEstatesStrategy.Anumberofareas
aredependentonthecompletionoftheseseparate
planssuchastheprovisionofadditionaltheatrecapacity
attheRoyalLancasterInfirmarysite.
TheEstatesStrategywill,inthefirsttwoyears,focus
onanumberofkeyimprovementstoclinicalefficiencies
andpatientexperience.Thesewillincludethecarpark
improvementsattheRoyalLancasterInfirmary,which
willsignificantlyimprovefacilitiesforpatients,their
relativesandourstaff,andworkwithourpartners
inthelocalhealtheconomytodeliveroutofhospital
benefitsinthecommunity.
AttheFurnessGeneralHospitalsitethebettercare
togetherStrategyenvisagesanadditionaltheatreand
remodellingoftheEmergencyDepartmenttoimprove
patientflowandclinicaladjacencies.
DuetothecomplexnatureoftheRoyalLancaster
Infirmarysiteasequenceofmovesisrequiredtorelocate
existingclinicalandeducationaldepartmentstoallowthe
developmentoffournewtheatreslocatednexttothe
existingmainfourtheatres,providingasurgicalflooron
level1.TheTrustmustfirstconstructtheadditional
groundfloorexpansionofthecentenarybuilding.
Theamountofcapitalinvestmentattributableto
the‘bettercaretogether’Programmeamountsto
£55million.Itrepresents22%ofthetotalinvestment
of£246mrequiredaspartofourexpandingplansto
maximiseourhospitals.
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40 A great place to be cared for; a great place to work.
5.5 Our service development ambitions
TheTrust’swiderproposalstoreconfigureourestate
will,throughimprovedclinicaladjacencies,improve
patientsafetyandachievestaffingefficiencies.
TheTrustproposesanumberofdevelopmentswithin
itsestate,someofwhichhavetobeimplementedas
partofbettercaretogether.
AtFurnessGeneralHospitalwewillimprovethe
WomenandChildren’s,AcuteMedicineandCore
ClinicalDivisionareas.
AtRoyalLancasterInfirmarythemajorexpansionofthe
coreCentenaryBuildingisneededtoaccommodate
elementsofthebettercaretogetherschemebutalso
amajorrestructurewherekeyhospitalfunctionsare
locatedonthesite.Theschemewillallowallclinical
activitytobelocatedforthefirsttimeintoasingle
modernbuildingonthesite,withperipheralbuildings
vacatedanddemolishedorsold.
ParticularbenefitsatRoyalLancasterInfirmarywillbe:
•Allmedicinewardsclusteredinasingleblock
oftheflexibleCentenaryBuildingafterexpansion,
allowingeconomiesofstaffing;
•Allsurgerywardsandtheatresclusteredona
singlefloor,allowingeconomiesofstaffingand
betterpatientexperiencewhentransferred
betweenwardsandtheatres;
•Replacementofthecurrentunfit-for-purposeunits
foroncologyandophthalmology;
•ReprovisionoftheBloodScienceslabstoensure
continuedaccreditation;
•EndingthedrainonrevenuefundsforPatient
TransportAmbulancesandtaxisusedtotransport
patientsbetweendifferentpartsoftheRoyal
LancasterInfirmarysiteseparatedbyasteephill;
•Endingthesimilarproblemforlaundry,catering,
mortuary,wasteandotherserviceswhichhavetouse
tugsandvanstonegotiatethesteepinternalslope;
•Modernwarddesignwith50%singlerooms,
betterstorageanddistributednursebases;
•Moreflexibilitytorespondtodifferentproportions
ofmenandwomenintheAcuteMedicaland
AcuteSurgicalunits.
Buildingonthegrowingreputationofmedicaltraining
attheTrustandLancasterUniversity,anewEducation
andConferenceCentrewillbecreatedwithinthe
Grade2listedbuildinginthenorthernquarterofthe
site.ThiswillmaketheTrust’seducationalspacefitfor
asuccessfulfuture.TheschemewillalsocombineTrust
HQandsupportadministrationintoasinglelocation,
improvingoperationalefficiencyandreducingrunning
coststhroughthelong-awaiteduseofopenplan
administrativeoffices.
Thisplanassumesthatsufficientfinancewillbe
availabletosupportourestatesredevelopment
strategytosupportboththebettercaretogether
proposalsandtheTrust’sownproposals.
QueenVictoriaHospital,whichcurrentlyprovides
outpatientservices,willhaveitsrolereinforcedasa
sitedeliveringcommunityservices,withsomeactivity
transferringtherefromtheRoyalLancasterInfirmary
underbettercaretogether.
SummaryofourFiveYearStrategicPlan|2015-2020
41 A great place to be cared for; a great place to work.
6.1 Overview
TheTrust’sI3Strategy,approvedinMay2013,identified
eightkeythemesofdevelopmenttoenabletheTrust
tomoderniseandtransformhealthcaredelivery
supportedbycomplexinformatics.Theseeightthemes
remainvalidtodayandprovideasuitableframework
todevelopandgovernthiscomplexarea.Therehas
beensignificantprogressoverthepasttwelvemonths,
howevernewoperationalneedsandobjectives,
includingbettercaretogether,havepromptedthe
needforthestrategytobereviewed.
Asignificanteventwithinthisstrategywillbethe
formalend,inJuly2016,ofthenationalcontracts
forthedeliveryoftheTrust’sePR(Lorenzo)and
Theatre(Ormis)systems.ABusinessCasewillbe
preparedoutliningtheoptionsofre-procurementor
replacementofthecontracts.
Diagram 7: Key Milestones (next 12 – 24 months)
6.2 The electronic Patient Record (ePR)
TheI3Strategyfullysupportsthecontinueddevelopment
oftheTrustelectronicPatientRecord(ePR)Programme.
TheePRProgrammeisveryambitiousandisstillahead
ofmostotherHospitalTrusts.Overthenext24
monthstheprogrammewilldeliverelectronicPrescribing
andMedicationAdministrationacrossallourwards
anddepartments,electronicrequestingofdiagnostic
tests,somemedicaldeviceintegrationandamobile
workingcapability.Alltheabovework-streamswill
provideafirmplatformtoengageonaformalinpatient
paper-liteprojectthatwouldpotentiallystartin2016.
ImprovingdataqualityisakeycomponentoftheI3
strategy.Promotingdataqualityiseveryone’s
responsibilityanddevelopingacultureof“gettingit
rightfirsttime”arekeypriorities.
Section 6IT and informatics strategy
Apr 2016 - Local ePR Contract in effect
Aug 2014 - First year review of 13 Strategy
Feb 2015 - ePrescribing and Electronic requesting of Pathology and Radiology Plans
Dec 2014 - ePR Contract Replacement Business Care for Approval
Sept 2014 - Assurance of IPPMA module of Lorenzo
June 2015 - Bettercaretogether Implementation Commences
Apr 2015 - Completion of 13 Structural Changes
SummaryofourFiveYearStrategicPlan|2015-2020
42 A great place to be cared for; a great place to work.
6.3 Clinical coding
Improvingthequalityandtimelinessofclinicalcoding
isaprioritytosupportthecompletenessoftheePRas
wellastheTrust’scontractualandfinancialprocesses.
TheI3strategyidentifiesfundingfortheintegration
ofclinicalcodingencodingsoftwarewithinLorenzo
whichhasthepotentialtoimprovecodingaccuracy,
completeness,incomegenerationsupportandcoding
auditgovernance.
Akeycomponentofthestrategyistheopportunity
tointegratecross-organisationallyandsupportend-
to-endclinicalcarepathways,supportingefficient
healthcare.Thestrategysupportsworkingwithour
twoClinicalCommissioningGroupsandpartner
providerorganisationsandothertertiarycentres.
Todatewehavemadeprogresswithprimarycare
throughdevelopmentsviatheMedicalInteroperability
Gateway(MIG)andtheStrataPathwayssystem.
TheI3strategyrecognisestheimportanceof‘end
toendcare’,andourapproachesandcapabilities
willsupportcreativemodelsofhealthcaredelivery
beingdevelopedbythebettercaretogetherInitiative
andthewiderNHS.Thestrategyhasdefinedtwo
significantrequirementsfortheI3Strategy;aunified
Information/Informaticsfunctionandabusiness
intelligencecapability.
6.4 Integrated informatics
ThebettercaretogetherStrategyhasdesignedanew
healthcaremodelwithintheMorecambeBayfootprint.
Thisstrategydescribeshowanextendedhealth
communitycoulddevelopanintegratedInformatics
environmentabletoproactivelysupporthealthcare
delivery.ThegoalofthisstrategyistopresentanePR
viewtocliniciansatthepointofcareorpointofclinical
decisionsi.e.ateverypatientcontactpoint.
Thevisionbuildson:-
•usingcurrentexistingsystemsinvestment,
• identifyinggapsincurrentsystemscapability;
• recommendingamodularprocurement
• significantprogressmadeineachcontributing
organisation.
Thisintegratedpatientrecordviewiscomplemented
witheffectivemultiorganisationalcareplanningand
resourcemanagementalongwithaneasytoaccess
knowledgelayer.Thevisionbuildsonthestrategiesof
thedifferentorganisationalsystems.Thebettercare
togetherinitiativerequiresarobustandprofessional
informaticscapabilitytodeliverthisvisionandalso
asingleservicemodeltosupportitmovingforward.
UHMBTMorecambeBaySharedInformaticsServiceis
ideallyplacedtoundertakebothfunctions.
6.5 Progress
Initsfirstyear,theI3Strategyhasbeensuccessfuland
confirmsthatthemainthemesoftheStrategyremain
valid.Itconfirmsthattheprimarydriveofthestrategy
tomovetheTrustintoapaper-liteworldiscorrect
one,toenablethetransformationofworkingpractices
andenablingthebettercaretogetherinitiative.The
StrategyhighlightstheneedforstrongClinicaland
Executiveleadershiptoembedthiscomplexandcrucial
agendaintotheTrust’s“businessasusual”operations.
ItidentifiestheneedforDivisionalChiefClinical
InformationOfficersandaformalChiefNursing
InformationOfficeraswellasarollingsecondment
programmeofeightWTEtodesignanddeployand
embedfuturechangedpractices.Inadditiontothe
workstreamsalreadyidentifiedinthisdocumenta
furtherquickwinhasbeenidentifiedasaresultoffull
rolloutoftheelectronicAdviceandGuidancesystem.
OurI3strategyidentifieseightthemesfordevelopment
whichwillenablesignificanthealthcareimprovements
andareoutlinedonthenextpage.
SummaryofourFiveYearStrategicPlan|2015-2020
43 A great place to be cared for; a great place to work.
1: The need to reorganise the way we manage
our Informatics and Information resources
Thisthemedescribestheneedforclarityandfora
singlefunction,providingtheTrustasinglepointof
contactforeverythingtodowiththiscomplexagenda.
2: Complete the Lorenzo patient record
deployment and rollout.
UHMBThasdeployedasignificantelectronicPatient
Recordplatform,withtwokeycomponentsstilltobe
deployed:-ePrescribingandelectronicrequestingof
tests,witharolloutrequiredaroundtheTrustestate.
AnintegratedsolutionisalsorequiredforTheatresand
afullbusinessisrequiredinearly2015.
3: The need for business intelligence
Informationthatdescribestheoperationsofthe
Trustcomparesuswithourpeergroupandprovides
trendingcapabilitiestoassistwithpredictivemodelling
offutureserviceconfigurationsandpatientflow;
providesahigh-leveldashboardtypeviewofTrust
performanceagainstasetoflocallydefinedinitiatives.
4: A new I3 governance structure
Designedtoprovidevisibilityandaccountabilityforthe
wholespectrumoftheI3agendatobeimplemented.
5: eHospitals or paper-lite hospitals
ThisisthegoalofthedigitalelectronicPatientRecord
agenda,andthisshouldhavematuredtobeableto
supportpaperliteinpatientcarein2016.
6: Develop and maintain a project portfolio
Thestrategydefinesthatamorebusinessgrounded
managementoftheI3agendaisneeded,achievedby
publishingafullprojectportfolioofwork,withproject
alignmenttoitsbusinessdrivers,expectedbenefits
andnotecurrentstageofdelivery.Alongsidethe
portfoliowillbeanI3blueprintshowingthecurrent
landscapeofsystemsandcapabilitiesconfigurationat
thecommencementofthisstrategylifecycleandalso
whereweexpecttobeattheend(2019).
7: Inter-operability with other health community
patient record systems.
Todeliverclinicalcarealongpathways,involving
multipleorganisations,andtofacilitatetheITagenda
tosupportbettercaretogether,individualorganisations
needtoownandmaintaintheirownpatientrecord
systems.Thisstrategydescribeshowtheappropriate
levelofdataexchangeandviewingbetweenclinicians
acrossorganisationalboundarieswillbedevelopedto
supportthemosteffectivedeliveryofcare,wherever
thepatientisontheirpathwayofcare.
8: Infrastructure.
Ourtechnologyinfrastructureiswelldesignedand
robustandisapreciousasset.Wewillbuildonthis
toensurethatmaintenanceandsupportforthis
infrastructureandprovisionoftherequiredtechnical
toolstosupportmodernhealthcare,isgiven
sufficientpriority.
SummaryofourFiveYearStrategicPlan|2015-2020
44 A great place to be cared for; a great place to work.
7.1 Overview
AstheTrustprogressesonitsqualityimprovement
journeyadetailedQualityImprovementPlanhas
beendevelopedtoensurethatweallworktogether
toachieveourcommitmentofdeliveringsafe,high
qualitycareforallofourpatients,aswellasmaking
ourhospitals,modernandefficientplacestowork.
YearOneoftheQualityImprovementPlanisimportant,
itistheyearwewilladdresstherecentfindingsofthe
CareQualityCommission.
Toensuretheimprovementscanbesustainedand
totacklesomeofthelongstandingissuessuch
asculture.Wehavealsobeguntoestablishan
ImprovementHub.
TheImprovementHubwillprovidesupportandassistance
toourstaff,helpingthemtofullyunderstandwhat
‘good’and‘outstanding’looklikeandproviding
themwiththetoolstoachieveit.TheHubapproach
willassiststafftousetriedandtestedtechniquesfor
deliveringconsistent,sustainablechange.
Everyoneknowsthatcommunicationiskeytothe
successofanyplan,ourplansforcommunicatingand
engagingwitheveryoneconnectedwithourhospitals
isequallyambitious.
OurQualityImprovementPlanreiteratestheTrust
Board’scommitmenttodeliveringhighstandardsof
safe,qualitycaretoourpatients,aswellasproviding
aworkingenvironmentandculturewhichpromotes
andwelcomeshonesty,safetyfirst,opennessand
compassionineverythingwedo.
7.2 What are we trying to accomplish?
Ourvisionistoconstantlyprovidethehighestpossible
standardsofcompassionatecareandtheverybest
patientandstaffexperience.Wewilllistentoand
involveourpatients,staffandpartners.
ThefocusofthisQualityImprovementPlanisthe
establishmentofourTrustasagreatplacetobecared
for,agreatplacetowork–itisarallyingcallforevery
singleemployee,volunteerandgovernortoensurethat
wedeliverexcellentcare,everytime,toeverypatient.
Our aim is to create a culture of continuous
improvement which is both patient-centred
and safety-focused. To do this, we must create
the conditions where we:
• Listentoandincludetheviewsofourstaffand
keystakeholders
• fullyembedtheTrustValuesineverythingthat
wedoinordertoensuretheworkingenvironment
isconducivetocontinualimprovementand
innovation
•activelyengagewithandenablestafftoleadand
delivermeasurablechangeandimprovement
• focusonhumanfactors-howwedelivercare
asteams.
Section 7Quality strategy
SummaryofourFiveYearStrategicPlan|2015-2020
45 A great place to be cared for; a great place to work.
Wemustalsoensurethatimprovementisseenand
understoodtobeeveryone’sbusinessby:
•expectingallteamsandstafftobeinvolvedin
improvementandinnovationaspartoftheir
everydaybusiness
• localteamsregularlydiscussingperformance,
innovationandimprovement
Thisplanthereforeaimstoprovidestaff,patients
andthepublicwithacleardescriptionofourquality
improvementandexperienceprioritiesandhowthese
willbemeasuredandmonitoredover2014-17.
Theoutcomesofthisplanlinkcloselytothosedescribed
intheTrust’sQualityAccountsandtheCareQuality
Commission’sdomainsofSafe,Effective,Caring,
ResponsiveandWellLed.Theydemonstratehowthe
Trustisworkinginpartnershipwithcommissioners
todevelop,designandimplementanintegrated
long-termqualityandservicestrategyforthewhole
healthcareeconomy.
OurQualityImprovementPlanwillfocusonthreekey
improvementoutcomes.Theseare:
Better To reduce mortality and harm
Care To provide reliable care
Together To improve patient and staff experience
Deliveringourthreekeyimprovementoutcomesof
better,careandtogetherwillinfluencethedelivery
ofimprovedserviceswhichareeffectiveandwill
demonstratemeasurableoutcomesrelatingtohow
theyimprovestandardsofcare,patientandstaff
experienceandcontributetoourfinancialandservice
performance.
Please see the Trust’s Quality Improvement Plan for more details
SummaryofourFiveYearStrategicPlan|2015-2020
46 A great place to be cared for; a great place to work.
SummaryofourFiveYearStrategicPlan|2015-2020
47 A great place to be cared for; a great place to work.
Inadditiontotheharmsundertheumbrellaof‘Safety
Thermometer’,ourambitionistoachievea50%
reductioninhospitalacquiredinfectionswithin12
monthsasmeasuredby:
8.1 History
ThetablebelowshowstheTrust’sfinancialposition
overthelastthreeyearsandtheforecastfor2014/15.
Thedeficithasincreasedfrom£1min2011/12
becauseoftheinvestmentsmadetoimprovethe
qualityoftheservicesdeliveredbytheTrust.These
investmentshavebeenpartlypaidforbynon-recurrent
financialsupportfromtheTrust’stwomain
commissioners.
Table 20:
Financial position 2011/12 – 2014/15
Summary 2011/12 2012/13 2013/14 2014/15
SOCI Actual ActualActualForecast
£m £m £m £m
Surplus/ (1.0) (23.0) (19.0) (27.0)
(deficit)
Includes0.05.07.56.0
support
Theneedtorecruitadditionalfrontlinestaffandthe
difficultyofrecruitingtocertainpostshasledtheTrust
toincurincreasedspendingoninterimstaffasshown
belowintable21.Recruitmentofpermanentstaff
isacentralpartoftheTrust’squalityandworkforce
strategiesandisalsoamajorthemeinfutureCost
ImprovementPlans.
Table 21:
Agency expenditure 2011/12 – 2014/15
Agency 2011/12 2012/13 2013/14 2014/15
Expenditure Actual ActualActualForecast
£m £m £m £m
Agency6.012.916.417.5
Expenditure
8.2 Underlying trading position
Theforecastdeficitfor2014/15is£27m.The
normalisedposition(i.e.excludingnon-recurrent
commissionersupportandotheritems)is£35m.
AdetailedanalysisoftheTrust’sstructuralcostshas
beenundertakenbyPwC;thishascalculatedthat
regardlessofhowefficientweweretobecome
throughnormalcostimprovementmeasuresthere
wouldstillbeadeficitof£20m.Thisisduetoour
geography,population,theessentialrequirementto
meetsafeandappropriatestaffinglevelsandtheneed
tomeetregulatorystandards.FurthertothistheTrust
needstocontinuetoinvestinitsworkforcetoensure
safestaffinglevels.
However,thecurrenttradingpositionisworsethan
plannedandthefinancialstrategythereforeincludes
anelementofsavingsabovethatanticipatedfromthe
2015/16tariffchangesinordertoreducethedeficit.
Section 8Financial Strategy
SummaryofourFiveYearStrategicPlan|2015-2020
48 A great place to be cared for; a great place to work.
8.3 Better Care Together
TheTrust’sfinancialstrategybuildsontheBetterCare
TogetherstrategydescribedinourclinicalStrategyand
diagram10outlinesthescenarioswhichwillimpact
uponourfinancialposition.
Diagram 10: UHMBT financial model
8.4 Assumptions
Thekeyassumptionsforourfinancialstrategyareas
follows:-
•Theforecastdeficitfor2014/15is£27m;
• Ithasbeenassumedthatfor2015/16onwards
thenationalefficiencyrequirementis3%perannum
andthateachyeartheTrustwillachieveaCIPof
£10m,whichisgreaterthanthe3%requirement;
•TheTrust’splanassumesvascularserviceswould
transferin2015/16;
•Demographicgrowthhasbeenestimatedat1%
perannumfrom2015/16andthishasbeenbuilt
intotheactivityforecast;
•ThepotentialimpactofBetterCareTogetherhas
beenincludedbasedonthe2yeardeliveryplan.
Ithasbeenassumedthatincomewillreducein
linewiththeTrust’splannedcostchanges;
•CapitalspendisbasedontheEstatesStrategy.
Thisshowsaspendof£251m2015/16to2018/19
andincludes£54mforbettercaretogether.
TheTrustrequiresPublicDividendCapitalto
supportthislevelofcapitalspend;
•Revenuesupportfromcommissionersisassumed
at£6min2014/15.For2015/16onwardsalocal
pricemodification,startingat£20mandrising
toreflectadditionalinvestment,isassumed.This
ofcourseissubjecttotheClinicalCommissioning
Groupsreceivingaspecificallocationtocoverthis;
•Asregardssevendayworkingthecostsassociated
withthishavebeenexcludedfromtheforecast
asitisexpectedthatfundingwillbemade
availablespecificallyviathetariff;
•BasedontheseforecaststheTruststillrequires
PublicDividendCapitaltosupporttheforecast
deficitaswellasthePublicDividendCapitalto
supportthecapitalinvestmentplan.
Do Nothing
TRUST CIP• Quality• Workforce• EPR• Estates• Commercial
CurrentDeficit£25-£30m
BETTER CARE TOGETHER
150Beds65ClinicsSiteCostsPremiumCosts
CIP-£9mperannum
£60-£70mperannum
ResidualFundingGap£8-10m
Local Price Modification
Better Care Together
1 2 3 4 5
SummaryofourFiveYearStrategicPlan|2015-2020
49 A great place to be cared for; a great place to work.
8.5 Cost improvement plans
TheexpectedCostImprovementPlanrequirement
of3%wouldgivetheTrustatargetof£8mbutthe
financialstrategyenvisagesaCostImprovementPlan
of£10mtoreducethedeficitovertheperiodoftheplan.
Diagram8belowoutlinesthemainCostImprovement
Plan(CIP)themesandsomeofthetoolswhichwill
beusedtoplananddeliverthesavingsrequired.
DetailedCIPplanningwithdivisionswillcommence
inNovemberandwillfollowtheapproachusedin
previousyearsforagreedschemesofcompleted
workbookswithmilestonesandallschemessubject
toQualityImpactandEqualityassessments.
AmainthemeoffutureCostImprovementPlanswill
bethereductionoftheuseofexpensiveagencystaff
aswerecruitpermanentlytoarangeofmedicaland
nursingandmidwiferyposts.
MonitoringandreportingofCostImprovementPlan
deliverywillcontinuetobeviaformalmonthlyreports
totheTrust’sFinanceCommittee.
SummaryofourFiveYearStrategicPlan|2015-2020
50 A great place to be cared for; a great place to work.
8.9 Procurement strategy
Duringthelastfewyearstherehasbeenanincreasing
focusontherequirementsfortheNHStoimprove
itsprocurementfunctiontocontributetowards
thenationalefficiencyprogrammebyeliminating
wastefulprocurementpracticesandreducingcosts.
Thishasbeenevidencedbytheissuingofanumber
ofreviewsandguidancedocumentsculminatingin
thepublicationof‘Better Procurement, Better
Value, Better Care: A Procurement Development
Programme for the NHS’.
TheTrustcontinuestousethisasaframeworkto
realiseitsambitionofcreatingamoderneffectiveand
efficientprocurementfunction,thattrulydeliversvalue
formoney,supportsinnovation,stimulatesgrowth
thathelpscontributetodeliveringthehighestquality
patientcare.
ThekeythemesuponwhichtheTrustprocurement
strategywilldevelop;
•Workmorecollaboratively-includingsharing
pricespaidtoensurethatallpaythesameprice
forthesameproductandundertakingjoint
procurementactivitiestoreducethe
‘managementcosts’;
•Developmentofpipelinetransformational
procurementprojects;
• Improvecontrolsonpurchasingtoensure
compliancewithcontracts;
• Increaseawarenessanddeliverthebenefitsof
strategicrelationshipmanagementtechniques,
toensurecontinuousimprovementanddelivery
ofcostsavings;
•ContinuethedrivefortheTrustprocurement
functiontobebetteratengagingandembracing
cliniciansinfosteringanddrivinginnovationand
change.Toofferprocurementasastrategictoolto
influenceandimprovepatientpathways;
•Providingvisibilityofspendtokeystakeholders
andExecutives.
Theprocurementstrategyisanenablerinallowing
theTrusttouseitsresourcestodeliverthemaximum
returnonitsexpenditure,providingthehighestquality
goodsandservicesforitspatients.Thestrategyseeks
toensureeachpoundisspentwiselyandspentwell.
Anumberofstrategicactionsthatwillimprovethe
performance,efficiencyandeffectivenessofits
procurementfunction,aswellascontributingtothe
overalldevelopmentofbetterprocurementacrossthe
Trusthasbeenset.
SummaryofourFiveYearStrategicPlan|2015-2020
51 A great place to be cared for; a great place to work.
8.10 Research and development
TheTrusthasahistoryofparticipatinginmulticentre
researchparticularlyinoncologyandsince2007this
researchactivityhasgrown.Followingtheestablishment
oftheCumbria&Lancashirecomprehensiveresearch
network(CLRN)theTrusttooktheopportunityto
expandtheresearchinfrastructuretoenableother
specialtieswithintheTrusttoundertakeresearch.
In2007/8191patientswererecruitedintoNIHR
portfolioresearchstudies,by2013/14therecruitment
figureshadincreasedto1013patientsrecruited
toNIHRportfolioresearch.Howeverthereremains
considerablescopetofurtherincreaseresearchactivity
andpatientrecruitmentwhichshouldresultinan
increaseinpatientchoiceandqualityofcare.Our
ambitionforresearchanddevelopmentisakeypart
ofourstrategicplanandwewillaimto:
1. Toraiseourprofileanddevelopourreputation
forresearchexcellence
2. Torecruitmorepatientsandattractadditional
income
3. Todevelopandembedaresearchculture
Theresearchanddevelopmentteam,withthesupport
oftheExecutiveteamandtheTrustBoard,will
implementtheresearchstrategyfocusingonthe
followingportfoliosoverthenext3years.
1.Tocommitto2-6jointclinicalacademic
appointment’swithLancasterUniversity
2.Clinicalacademia–alignmentwithuniversity,
allowingustogrowourownstaff
3.Researchactivityineveryareabutwithspecific
areasdevelopedasspecialityresearchareas
4.Recruit5%moreparticipantsintoNIHRstudies
eachyear
5.Tohavegreaterthan15%ofallclinicalstaff
activelyinvolvedinresearchanddevelopment
6.Increasecommercialtrialincomeby25%over
thenext3years
7.Secureadditional£200Kresearchfunding
SummaryofourFiveYearStrategicPlan|2015-2020
52 A great place to be cared for; a great place to work.
Research strengthCurrentresearchactivityisinfluencedbytheNIHR
portfoliowhichfocusesonNHSorganisationsproviding
abroadportfolioofresearchinallspecialties.
Approximately85%ofthefundingfortheR&D
departmentiscurrentlyprovidedbytheNIHRandas
suchweneedtomaintainthisbroadresearchportfolio.
TheTrustdoeshaveanumberofresearchstrengths,
wherewehavehadactiveprojectsconsistentlyover
thelastthreeyearsandsomedevelopingresearch
areas,wherewerunstudieseitherintermittently
orhavenewlyengagedinresearchwithinthelast
18months.Bothareasareledbyenthusiasticlocal
consultantswithboththeareasofstrengthandthe
developingareashavepotentialforgrowth.
TheTrustisamemberoftheNIHRNorthWestCoast
ClinicalResearchNetwork(NIHRNWCCRN).Academic
partnershipscurrentlyexistwiththeUniversitiesof
Lancaster,Liverpool,Cumbria,Manchesterand
CentralLancashire.
Undergraduate and post graduate research opportunitiesTheTrustthroughtheundergraduatemedicaleducation
teamcurrentlyisabletosupport6medicalstudentsa
yearthroughanintercalatedMScdegreebyresearch.
Thesestudentsareusuallyjointlysupervisedbyan
academicfromtheUniversityofLancasterandan
employeeoftheTrust.
Similarlythereisfundingeachyearforonenon-
medicalstudentPhDstudentship,againjointly
supervisedbyanacademicfromtheUniversity
ofLancasterandanemployeeofTrust.
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53 A great place to be cared for; a great place to work.
Commercial researchCurrentcommercialresearchactivitysponsoredby
pharmaceuticalordevicescompaniesissmallbut
increasingandthereishugepotentialforgrowthin
thisareawhichwewillaimtopursue.
TheTrustscommitmenttoresearchanddevelopment,
stronglysupportedbyourclinicalleaders,willhelpto
buildourreputationandexpandourportfolioasakey
contributortoresearchbothlocallyandnationally.
8.11 Performance Monitoring
TheTrust’sfiveyearstrategywillbeusedtoinform
concurrentannualplanningprocessestoinform
detaileddeliveryplans.Thiswillinclude;
•AreviewoftheimpactoftheannualNHS
PlanningGuidance,includingNationalTariff
impact;
•Anannualassessmentandapplication
(whererelevant)foranappropriateLocal
PriceModification;
•Ariskreviewtoinformtheidentificationand
appropriatemitigationofkeystrategicrisks;
•ThedeliveryoftheStrategicObjectiveswill
bemonitoredmonthlyviatheBoardAssurance
CommitteesandQuarterlytotheBoardof
DirectorsviatheTrustManagementBoard.
Thiswillincludeadetailedreviewofriskand
atwoyearoreightquarterforecastbasedon
performanceoverthepriorperiod.
SummaryofourFiveYearStrategicPlan|2015-2020
54 A great place to be cared for; a great place to work.
Conclusion
TheTrust’sfiveyearstrategyfortheperiodto2019/20
representstheculminationoftwoyears’work,
deliveredinpartnershipwithourkeypartnersinthe
LocalHealthEconomyandrepresentativesfromour
widerhealthcommunity.
Thesuccessfuldeliveryofthisstrategyreliesonthe
entirehealtheconomycomingtogethertomanage
ourhealthservicesholisticallyandunderthetheme
ofintegration–acorecomponentofthebettercare
togetherplanswhichhavebeensigneduptoby
respectivegoverningbodies.
Subjecttotherelevantsystemsupport,bothfinancial
andstrategic,thedeliveryofthestrategywillensure
accesstogoodqualityservices,withimproved
outcomesforourpatientsatalevelofinvestment
thatrepresentssignificantvalueformoneygiventhe
uniquegeographicchallengesUHMBTface.
Section 9Conclusion
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55 A great place to be cared for; a great place to work.
SummaryofourFiveYearStrategicPlan|2015-2020
56 A great place to be cared for; a great place to work.
Appendices
Appendix1:
Risk and Mitigation table
Appendix2:
Local Health population analysis
Appendix3:
Market appraisal
Appendix4:
The 2 year operational delivery model
Appendix5:
The Workforce Values
Appendix6:
The Communication Strategy
Appendix7:
Estates Strategy Proposals
Appendix8:
Funding Principles to support Innovation,
Informatics and Information
Appendix9:
Procurement Strategy Deliverables
Contact us
UniversityHospitalsofMorecambeBayNHSFoundationTrust
TrustHQ
WestmorlandGeneralHospital
BurtonRoad
Kendal
LA97RG
Email [email protected]
Twitter twitter.com/UHMBT
Facebook facebook.com/UHMBT
Tel 01539 716695 (Trust HQ)
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pleasedonothesitatetocontactus.
Dateofpublication:10 February 2015Version:1.0